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MEDICAL  WORKS 


OF 


EDWARD  MILLER,  M.  D. 

I-ATE    PROFESSOR    OF    THE    PRACTICE    OF    PHYSIC    IN    THE 
UNIVERSITY    OF    NEW-YORK,    AND    RESIDENT    PHY- 
SICIAN   FOR    THE    CITY    OF    NEW-YORK. 


COLLECTED,   AND    ACCOMPANIED    WITH 

A    BIOGRAPHICAL    SKETCH 

OF  THE  AUTHOR; 
BY  SAMUEL  MILLER,  D.  D. 

PROFESSOR   OF  ECCLESIASTICAL   HISTORY   AND   CHURCH   GOVERNMENT,   IN   THE 

THEOLOGICAL   SEMINARY    OF   THE   PRESBYTERIAN   CHURCH  IN  THE 

UNITED  STATES,  AT  PRINCETON,  NEW-JERSEY. 


NEW-YORK: 

PRINTED    AND    SOLD    BY    COLLINS    AND    CO, 
NO.    189,    PEARL-STREET. 

1814. 


Jv  *4  P 


Dtjirici  of  Nnu-York,fi. 


Bi 


)E  IT  REMEMBERED  that  on  the  feventh  day  of  May,  in  the 
thirty  eighth  year  of  the  Independence  of  the  United  States  of  America, 
(L.  S.)     Thomas  Collins,  Isaac  Collins,  and  Stacy  B.  Collins,  of 
the  faid  Diftrift,  have  depofited  in  this  office  the  title  of  a  book,  the 
right  whereof  they  claim  as  proprietors  in  the  words  following,  to  wit : 
"  The  Medical  Works  of  Edivard  Miller,  M.  D.  late  professor  of  the  Practice  of 
Physic  in  the  University  of  Ne-w  York,  and  Resident   Physician  for  the  city  of  Netu- 
York.      Collected,  and  accompanied  -with  a  Biographical  Sketch  of  the  Author  ;  by  Samuel 
Miller,  D   D.  professor  of  Ecclesiastical  History  and  Church  Government,  in  the  Theolo- 
gical Seminary  of  the  Presbyterian  Church  in   the    United  States,  at  Princeton,    New 
Jersey." 

IN  CONFORMITY  to  the  Act  of  the  Congrefs  of  the  United  States,  entitled, 
n  An  Aft  for  the  encouragement  of  Learning,  by  fecuring  the  Copies  of  Maps, 
Charts,  and  Books,  to  the  Authors  and  Proprietors  of  fuch  Copies,  during  the 
time  therein  mentioned  ;"  and  alfo  to  an  Aft,  entitled,  "  An  Act  fupplementary 
to  an  Act ,  entitled,  An  Aft  for  the  encouragement  of  Learning,  by  fecuring  the 
Copies  of  Maps,  Charts,  and  Books,  to  the  Authors  and  Proprietors  of  fuch  Copies, 
during  the  times  therein  mentioned,  and  extending  the  benefits  thereof  to  the  Arts 
of  Deigning,  Engraving,  and  Etching  HLftorical  and  other  Prints." 

THERON  RUDD.- 
Cltrk  of  the  New-York  District. 


PREFACE. 

IN  a  few  days  after  the  decease  of  his  Brother, 
the  editor  of  the  present  Volume  received  a  letter 
from  Doctor  Rush,  of  which  the  following  is 
an  extract ■ 

"  I  continue  to  sympathize  with  you  in  the 
loss  of  your  excellent  Brother,  and  my  much  lov- 
ed Friend. 1  wish  you   would  collect  and 

publish,  in  one  Volume,  all  his  original  Papers, 
which  lie  scattered  through  the  "  Medical  Repo- 
sitory," as  well  as  his  Inaugural  Dissertation. 
They  will  be  a  valuable  addition  to  the  medical 
science  of  our  Country,  and  are  calculated  to  do 
much  good.  I  will  endeavour  to  write  some  ac- 
count of  his  Life  to  be  prefixed  to  the  volume. 
It  will  be  gratifying  to  me  to  be  placed  upon  re- 
cord with  him  in  the  libraries  of  America,  and  to 
appear  before  the  public,  and  those  who  may 
come  after  us,  as  his  friend." 

It  will  readily  be  supposed  that  the  opinion  of 
such  a  Man  had  much  influence  in  exciting  the 
editor  to  the  present  undertaking.  On  consult- 
ing other  Friends,    who  are  entitled  to  his  confi- 


IV  PREIACE. 

dence,  he  found  them  unanimously  concurring 
in  judgment  with  the  venerable  Professor  of 
Philadelphia.  Thus  encouraged,  he  resolved, 
more  than  eighteen  months  ago,  to  enter  on  the 
task  without  delay.  A  variety  of  circumstances, 
however,  with  which  it  would  be  improper  to 
trouble  the  public,  have  prevented  the  execution 
of  his  plan  till  the  present  time. 

The  reader  will  perceive,  from  the  foregoing- 
extract,  that  a  Sketch  of  the  Life  and  Character 
of  Doctor  Miller  was  promised  by  One  "  who 
touched  nothing  which  he  did  not  adorn. "  Had 
his  invaluable  life  been  spared,  a  memorial  of  his 
Friend  might  have  been  expected,  far  more  in- 
teresting than  even  fraternal  affection  has  been 
able  to  form.  But,  alas  !  this  purpose,  as  well 
as  others  of  much  greater  importance,  was  broken 
off  by  death.  The  editor,  under  the  circum- 
stances in  which  he  was  placed,  felt  constrained 
to  undertake  himself  the  melancholy  task.  With 
respect  to  the  whole,  he  will  only  say,  that  if  he 
had  not  considered  the  volume  to  which  the  at- 
tention and  patronage  of  the  public  are  now  re- 
spectfully invited,  as  calculated,  in  some  degree, 
to  do  good,  he  certainly  would  have  forborne 
the  agency  which  he  has  had  in  committing  it  to 
the  press. 

Princeton,  N.  J.  7 
April  6th,  1814.  5 


CONTENTS. 


PAGK. 

A  Biographical  Sketch  of  Edward  Miller,  M.  D.  ix 

Dissertatio  Medica  Inauguralis,  de  Physconia  Splenica,  1 

Cursory  Observations  on  that  form  of  Pestilence  called 

Yellow  Fever,  41 

Report  on  the  Malignant  Disease,  which  prevailed  in  the 
city  of  New-York,  in  the  autumn  of  1805:  addressed 
to  the  Governor  of  the  State  of  New-York,  81 

Some  Remarks  on  the  Importance  of  the  Stomach  as  a 
Centre  of  Association,  a  Seat  of  Morbid  Derangement, 
and  a  Medium  of  the  Operation  of  Remedies  in  Ma- 
lignant Diseases,  153 

An  Attempt  to  deduce  a  Nomenclature  of  certain  Febrile 
and  Pestilential  Diseases  from  the  Origin  and  Nature 
of  their  Remote  Cause,  179 

An  Introdmtory  Lecture, on  the  influence  of  Temperature 

on  Health  and  National  Character,  '  203 

Introductory  Lecture,  on  the  Certainty  of  Medicine,  243 

Introductory  Lecture,  upon  Medical  Education,  269 

An  Inquiry  concerning  Cutaneous  Perspiration,  and  the 

Operation  and  Uses  of  Sudorific  Remedies,  239 

Remarks  on  the  Effects  of  Abstinence  at  the  approach  of 
Acute  Diseases.  323 

Observations  on  the  Phenomena,  Causes,  and  Treatment 
of  Sea-Sickness.  347 

Remarks  on  the  Cholera,  or  Bilious  Diarrhoea  of  Infants,      375 


ERRATA. 

Page  47,  line  lath,  (of  the  Biographical  Sketch)  for  spareina  read  ifAirsenf.' 

Page  34,  line  9th,  do.  for  Pro/Visional  read  Professorial. 

Page  92,  iine  14th  do.  for  stick  read  strike. 

Page  211,  line  2Gth,  for  portray  read  poetry. 

Page  229,  line  4th,  for  these  road  those. 

Page  292,  line  7th,  for  could  read  mould. 


BIOGRAPHICAL  SKETCH 


OF 


EDWARD  MILLER,  M.  D. 


BIOGRAPHICAL  SKETCH,  &c. 


IF  the  writings  of  a  deceased  author  be  thought 
worthy  of  preservation  and  perusal  at  all,  they  will 
generally  be  read  with  more  interest  when  accom- 
panied with  some  account  of  his  life  and  character. 
This  is  especially  the  case,  when  the  character  of 
the  Man,  if  faithfully  portrayed,  instead  of  tar- 
nishing the  reputation  of  the  Author,  is  rather  cal- 
culated to  increase  its  lustre. 

m 

If  the  writer  of  the  present  sketch  had  not 
believed  that  a  correct  portrait  of  his  deceased 
Brother,  would  both  give  pleasure,  and  enhance 
the  value  of  the  succeeding  sheets,  he  should,  on 
various  accounts,  have  shrunk  from  the  mournful 
task  of  attempting  to  exhibit  such  a  portrait.  He 
is  avare  that,  in  undertaking  to  speak  of  so  near 
a  Relative,  he  stands  on  delicate  ground.     After 


xii  Biographical  Sketch. 

the  most  mature  reflection,  however,  he  cannot 
perceive  any  good  reason,  why  the  witness  who 
of  all  others  may  be  supposed  to  be  best  qualified 
on  the  score  of  a  knowledge  of  facts,  should  be 
prevented  from  giving  testimony.  But  he  hopes 
in  a  great  measure  to  escape  the  charge  of  partial- 
ity, by  confirming  his  own  testimony,  for  the  most 
part,  and  especially  in  cases  in  which  fraternal  af- 
fection might  be  supposed  likely  to  sway  his 
judgment,  by  the  testimony  of  other  and  more 
uninterested  witnesses. 

He  will  only  further  observe,  by  way  of  pre- 
liminary, that,  if  he  be  found,  as  he  probably  will 
be,  in  the  following  pages,  especially  where  medi- 
cal opinions  and  characters  are  in  question,  to  ex- 
press himself  crudely  or  inaccurately,  he  hopes  it 
will  be  recollected  that  he  is  no  Physician  ;  and 
that  his  time  did  not  allow  him,  in  the  rapidity  of 
composition,  to  consult  a  medical  guide.  He 
trusts,  however,  that  no  material  misrepresentation 
will  appear  in  the  facts  attempted  to  be  recorded. 

Edward  Miller  was  a  native  of  Dover,- ^n 
the  State  of  Delaware.  He  was  born  on  the  9tn 
of  May,  1760.  His  Father  was  the  Reverend 
John  Miller,  A.  M.,  who  for  more  than  forty 
three  years,  sustained  the  office  of  Pastor  of  the 
Presbyterian  church  in  Dover,  and  who  died  in 
the  month  of  July,  1791,  pious,  faithful,  and  be- 


Biographical  Sketch.  xiii 

loved.  His  Mother  was  Margaret  Millington, 
daughter  of  Allumby  Millington,  Esquire,  of  Tal- 
bot County,  Maryland,  a  woman  of  extraordinary- 
prudence,  piety  and  benevolence,  who  was  re- 
moved by  death  about  eighteen  months  before 
her  husband. 

Edward  was  their  third  son  ;*  and  received  the 

*  The  eldest  son  was  John  Miller,  who  studied  Medicine, 
and  had  engaged  in  the  practice  of  his  profession,  in  the 
neighbourhood  of  his  Father,  a  short  time  before  the  com- 
mencement of  the  revolutionary  war.  In  1776,  he  entered 
the  American  army,  as  a  volunteer  surgeon  ;  and  died,  in  the 
month  of  February,  1777,  in  the  25th  year  of  his' age,  on  his 
way  from  the  military  hospital  in  New-Jersey,  to  pay  a  short 
visit  to  his  Parents. 

The  fourth  son  was  Joseph  Miller,  who  was  bred  a  coun- 
sellor at  law.  He  was  engaged  for  a  number  of  years  in  the 
successful  practice  of  his  profession,  and  was  more  than  once 
a  member  of  the  Legislature  of  his  native  State.  He  died  at 
Wilmington,  in  Delaware,  of  the  Yellow  Fever,  in  September, 
1798,  a  few  weeks  after  his  marriage,  and  in  the  34th  year  of 
his  age. 

The  youngest  son  was  James  Miller,  who  was  also  bred  to 
the  Law,  and  who  died  of  a  pulmonary  consumption,  in  South 
Carolina,  whither  he  had  gone  for  the  benefit  of  his  health,  in 
the  year  1795,  just  as  he  had  concluded  his  siudies,  and  was 
about  to  enter  on  the  practice  of  the  law. 

These  three  Brothers  were  considered,  by  those  who 
knew  them,  as  men  of  superior  talents.     They  certainly  en- 


xiv  Biographical  Sketch. 

early  part  of  his  education  under  the  eye  of  his 
Parents.  Under  his  paternal  roof  he  spent  the 
first  fourteen  years  of  his  life  ;  and  here  he  im- 
bibed, both  from  precept  and  example,  that  love  of 
truth,  those  sentiments  of  humanity  and  benevo- 
lence, that  candour,  that  prudence,  that  habitual 
respect  for  the  feelings  of  others,  and  that  mild- 
ness and  gentleness  of  deportment,  which  distin- 
guished him  in  so  remarkable  a  degree  through- 
out life. 

His  Father,  who  was  an  excellent  Latin,  Greek, 
and  Hebrew  scholar,  eommenced  his  instruction 
in  classic  literature.  At  about  the  age  of  fourteen, 
he  was  sent  to  a  seminary  which  then  enjoyed 
very  high  reputation,  in  the  village  of  Newark, 
in  his  native  State  ;  and  which,  though  not  in 
name,  was,  in  fact,  a  college.  Here,  under  the 
direction  of  the  Reverend  Doctors  Francis  Allison, 
and  Alexander  M'Dnwell,  who  were  successively 
principals  of  the  Institution,  with  the  assistance 

joyed,  in  a  very  high  degree,  the  respect  and  confidence  of 
their  native  State. 

The  second  and  sixth  sons  died  in  infancy.  The  fifth  only 
survives. 

Doctor  Miller  had  two  sisters.  The  eldest,  Mrs.  M'Lnne, 
of  Philadelphia,  who  survives  him  :  the  second,  Mrs.  Lock- 
irman,  afterwards  Mrs.  Patten,  of  Dover,  who  died  in  1801. 


Biographical  Sketch.  xv 

of  several  other  instructors,  he  devoted  four  years 
to  the  diligent  study  of  the  Latin  and  Greek  lan- 
guages, and  went  through  the  usual  course  of 
reading  in  the  arts  and  sciences.  He  had,  from 
very  early  life,  a  peculiar  taste  for  the  study  of 
the  classics.  And  being  so  happy  as  to  fall  into 
the  hands  of  able  teachers  in  this  branch  of  know- 
ledge, teachers  who  had  themselves  received  in- 
struction from  the  best  European  sources,  his  ac- 
quirements in  Grecian  and  Roman  literature  were 
much  more  extensive  and  more  accurate  than  are 
usually  made  in  this  country. 

Having  completed  his  academic  course,  in 
1778,  he  entered  on  the  study  of  medicine,  soon 
afterwards,  under  the  direction  of  Doctor  Charles 
Ridgely,  an  eminent  physician  of  Dover,  who  re- 
garded him  as  a  favourite  pupil,  and  always  treat- 
ed him  with  peculiar  and  affectionate  confidence. 

He  had  been  a  little  more  than  two  years  with 
Doctor  Ridgely,  when,  in  the  autumn  of  1780, 
fired  with  that  patriotic  ardour  which  he  mani- 
fested till  his  latest  breath  ;  not  at  all  discouraged 
by  the  loss  of  a  beloved  Brother,  who,  a  little  more 
than  three  years  before,  had  fallen  a  sacrifice  to  the 
hardships  of  the  revolutionary  contest ;  and  de- 
sirous, also,  of  enjoying  the  advantages  for  medi- 
cal improvement,  which  a  large  military  hospital 
peculiarly  affords  ;    he  accepted  the  appointment 


xvi  Biographical  Sketch. 

of  surgeon's  mate  in  the  army  of  his  country. 
In  this  capacity  he  served  a  little  more  than  a  year. 
This  time  was  chiefly  spent  in  the  Hospital  at 
Baskingriclge,  New-Jersey.  Here  with  the  vene- 
rable Doctor  Tilton,  with  Doctor  Lattimer,  with 
Doctor  Rodgers,  all  natives  of  his  own  State,  and 
with  a  number  of  other  respectable  Friends,  he 
passed  through  scenes  which  he  often  recollected 
and  described,  with  peculiar  interest  and  pleasure, 
in  after  life. 

In  the  latter  part  of  the  year  1781,  at  the  solici- 
tation of  some  friends,  he  accepted  the  place  of 
Surgeon  on  board  of  an  armed  ship  bound  to 
France.  In  this  voyage,  and  in  that  country,  he 
spent  the  greater  part  of  a  year.  He  carefully  im- 
proved the  opportunity  which  this  visit  to  Europe 
afforded  him,  not  only  to  acquire  the  French  lan- 
guage, which  he  ever  afterwards  read  and  spoke 
with  ease  ;  but  also  to  make  himself  acquainted 
with,  and  to  collect,  some  of  the  best  books,  and 
especially  some  of  the  best  medical  books,  in  that 
language.  He  found  great  advantages  afterward, 
from  having  enjoyed  and  improved  this  opportu- 
nity, when  Medicine,  as  a  science,  became  more 
successfully  cultivated  in  France,  than  it  had  been 
anteriour  to  the  time  of  Cullen  and  Brown. 

In  1782  Dr.   Miller   returned   to  his   native 
country,  and  brought  with  him  no  small  additions 


Biographical  Sketch.  xvii 

to  his  stock  of  knowledge.  In  each  of  the  two 
following  winters,  he  attended  regular  courses  of 
Medical  Lectures  in  the  University  of  Pennsyl- 
vania. It  was  during  this  period,  that  he  com- 
menced his  acquaintance  with  Doctor  Rush,  who, 
more  than  any  other  individual,  deserves  to  be 
styled  "  the  Father  of  medical  science  in  the 
United  States;"  an  acquaintance  which  he  highly 
prized,  and  which  was  afterwards  matured  into  an 
intimate  and  endearing  friendship.  Here  also,  in 
listening  to  the  able  instructions  of  Shippen,  Mor- 
gan, Kuhn,  and  others,  he  found  his  professional 
views  every  day  expanded,  and  his  information 
enlarged.  For  while  he  observed  and  thought 
for  himself,  and  always  attached  much  impor- 
tance to  experience  in  medicine  ;  he,  at  the  same 
time,  had  a  deep  impression  of  the  value  of  able 
Instructors,  and  of  well-constituted  Medical 
Schools. 

The  treaty  of  peace  in  1783,  terminating,  of 
course,  his  connection  with  the  army  and  navy,  he 
entered,  in  1784,  on  the  practice  of  his  profession 
in  the  village  of  Frederica,a.  short  distance  from  his 
native  town  in  Delaware.  A  few  weeks'  resi- 
dence, however,  in  that  place,  convinced  him  that 
the  prospects  of  success  there,  were  not  such  as 
he  ought  to  think  of  accepting  ;  and,  after  a  very 
short  trial,  he  removed  in  the  same  year,  at  the 
solicitation  of  some  particular  friends  of  the  family, 


xviii  Biographical  Sketch. 

to  Somerset  County  on  the  eastern  shore  of  Mary- 
land  Here,  in  a  polished,  wealthy,  and  hospitable 
neighbourhood,  he  spent  rather  more  than  two 
years, in  lucrative  practice,  and  in  pleasant  society. 

But  though  comfortable  with  respect  to  emolu- 
ment, and  happy  in  the  society  of  his  friends,  in 
Somerset  County,  there  were  two  things  which 
he  earnestly  desired,  and  after  which  he  inces- 
santly sighed.  The  peculiar  tenderness  of  his 
filiai  and  fraternal  affection  induced  him  to  wish  for 
a  residence  nearer  to  that  of  his  Parents,  and  the 
other  members  of  his  family  ;  and  he  was  anxious 
to  be  placed  in  a  situation  which  admitted  of  more 
easy  and  constant  intercourse  with  Philadelphia, 
which,  at  that  time,  he  regarded  as  the  principal 
focus  of  medicai  information  and  improvement  in 
the  United  States,  and  as  the  most  convenient 
medium,  within  his  reach,  of  communication  with 
the  European  worid.  Doctor  Miller,  therefore, 
in  the  year  1786,  when  the  lamented  death  of  his 
Preceptor,  Doctor  Ridgely,  and  some  other  cir- 
cumstances, opened  better  prospects  there  of  suc- 
cess to  a  new  medical  practitioner  than  had  for 
some  time  before  existed,  removed  to  Dover,  and 
entered  on  the  practice  of  his  profession  in  his  na- 
tive place.  Here  his  exemplary  attention  to  pro- 
fessional duties  ;  his  devotedness  to  study  ;  the 
character  which  he  maintained  for  unsullied  in- 
tegrity and  honour  ;  the  urbanity  of  his  manners ; 


Biographical  Sketch.  xix 

and  his  distinguished  benevolence  toward  all  who 
stood  in  need  of  his  gratuitous  services,  soon  con- 
ciliated public  confidence,  and  introduced  him  to 
a  practice  which  at  an  early  period  was  extensive, 
and  which  continued  to  grow  until  he  left  the 
country. 

Wherever  Doctor  Miller  resided,  it  became,  in 
a  little  time,  apparent,  to  all  who  were  on  terms 
of  intimacy  with  him,  that  pecuniary  considera- 
tions held  but  a  secondary  place  in  his  mind.  He 
was  ambitious  of  doing  good.  He  was  ambitious 
also  of  adding  to  the  stock  of  knowledge  in  his 
profession,  and  of  leaving  it  in  a  more  improved 
state  than  he  found  it.  Hence  he  not  only  sought 
with  eagerness  for  all  valuable  publications  on 
medicine,  both  ancient  and  modern;  but  he  sought 
by  close  and  accurate  observation,  and  by  care- 
fully recording  facts,  as  they  occurred  in  practice, 
to  increase  the  value  of  his  own  experience.  Nor 
was  he  less  careful  to  impart  to  others  the  result 
of  his  inquiries,  and,  by  a  comparison  of  obser- 
vations and  experiments,  to  render  those  results 
more  definite  and  certain.  Despising  all  the  arts 
of  nostrum-mongers  and  empirics,  and  open  as  the 
light  of  day  to  all  whom  he  considered  as  de- 
serving of  his  confidence  ;  he  was  anxious  to  have 
every  new  doctrine  and  remedy  subjected  to  the 
strictest  investigation,  and  made  as  public  as 
possible . 


xx  Biographical  Sketch* 

During  Dr.  Miller's  residence  in  Dover,  he  was 
in  the  habit  of  visiting  Philadelphia  at  least  once 
every  year.  To  this  annual  visit  he  was  induced, 
not  only  that  he  might  enjoy  the  pleasure  of  see- 
ing his  relatives  there,  toward  whom  he  always 
manifested  the  most  exemplary  affection  ;  but  also 
that  he  might  have  an  opportunity  of  personal  and 
unreserved  intercourse  with  some  of  the  most 
illustrious  Physicians  then  residing  in  the  United 
States  ;  that  he  might  collect  all  the  new  medical 
and  other  valuable  publications  from  abroad,  which 
flowed  into  that  literary  emporium  ;  and  that  the 
various  articles  of  medical  news,  which  his  corres- 
pondents had  failed  of  transmitting  to  him,  might 
not  wholly  escape  him. 

In  1739,  he  received  the  degree  of  M.  D.  from 
the  University  of  Pennsylvania.  On  this  occasion 
he  published  and  defended  an  Inaugural  Disser- 
tation, in  the  Latin  language,  De  Physconia 
Splenica.  He  was  induced  to  treat  of  that  disease 
from  the  frequency  of  its  occurrence  in  the  sphere 
of  his  practice.  The  endemics  of  that  part  of  the 
State  of  Delaware  are  Remittent  and  Intermittent 
Fevers  ;  and  an  enlargement  and  induration  of  the 
Spleen,  were  so  often  the  consequences  of  those 
protracted  and  debilitating  diseases,  that  the  sub- 
ject naturally  presented  itself  to  his  mind,  as  wor- 
thy of  particular  investigation.  In  the  opinion  of 
good  judges,  he  has  proved  himself  to  be  well  ac- 


Biographical  Sketch.  xxi 

quainted  with  this  distressing  and  obstinate  dis- 
order. He  differs  from  the  Nosologists  who  view 
it  as  an  idiopathic  disease  ;  and  contends  that  it 
is  almost  always  induced  by  intermittent  fevers. 
Hence  he  defines  it  to  be  "  Febrium  intermitten- 
"  tium  plerumque  sequela ;  tumor  in  regione 
"  Hypochondrii  sinistri  exortus ;  paulatim  cres- 
"  cens ;  durus  ;  saepe  indolens ;  nee  sonorus,  nee 
"  fluctuans  ;  quandoque  longe  et  late  diffusus  ;  et 
"  diutissime  permanens."  He  supposes  the  prox- 
imate cause  to  consist  in  a  sanguineous  conges- 
tion, and  languid  circulation  of  the  Spleen.  And 
recommends  the  removal  of  them  by  the  Peruvian 
bark,  and  other  tonics,  which  are  calculated  to 
lessen  the  remote  cause  ;  as  well  as  by  emetics, 
cathartics,  mercury,  electricity,  iron,  wine,  the 
cold  bath,  exercise,  friction,  and  change  of  cli- 
mate. His  observations  on  each  of  these  remedies 
have  been  pronounced  to  bear  the  marks  of  en- 
lightened and  careful  reflection. 

While  this  Dissertation  is  a  monument  of  his 
early  and  accurate  acquirements  in  medical  sci- 
ence ;  it  also  affords  an  honourable  specimen  of 
his  acquaintance  with  the  Latin  language.  The 
statutes  of  the  University  of  Pennsylvania,  at  that 
time,  required  all  Inaugural  Dissertations  for  the 
degree  of  Doctor  of  Medicine,  to  be  written  in 
that  language.  Doctor  Miller  found  no  difficulty 
in  complying  with  this  requisition.     Instead  of 


xxii  Biographical  Sketch. 

writing  his  essay  in  English,  and  procuring  it  to 
be  translated  into  Latin,  by  some  literary  jobber, 
as  has  been  always  but  too  commonly  the  case, 
even  in  European  Universities,  he  is  known  to 
have  written  it  originally  in  Latin,  and  wholly 
without  assistance.  And  although  the  praise  of 
a  refined  and  elegant  Roman  style  is  by  no  means 
claimed  for  it ;  yet,  when  it  is  considered,  that  the 
author  had  been  altogether  out  of  the  habit  of  wri- 
ting Latin  for  many  years  before  the  date  of  this 
composition,  it  is  presumed  that  every  one  who 
reads  it  will  pronounce,  that  his  early  acquire- 
ments in  that  language  could  by  no  means  have 
been  of  the  slight  or  ordinary  kind. 

It  was  a  short  time  after  Doctor  Miller's  set- 
tlement in  Dover,  if  the  writer  of  these  memoirs 
does  not  mistake,  that  the  Medical  Society  of 
Delaware,  received  its  first  organization.  In 
1789,  or  1790,  the  practice  of  delivering  an  An- 
nual Oration  before  that  body,  by  one  of  its  mem- 
bers, was  introduced.  Thejirst  Oration  was  de- 
livered, in  one  of  the  years  above  mentioned.,  by 
the  subject  of  this  sketch.  It  was  received,  at 
the  time,  with  much  and  warm  applause ;  and 
was  originally  intended  by  the  Editor  to  have 
been  introduced,  among  other  articles,  into  this 
volume  ;  but,  to  his  surprise  and  mortification,  no 
copy  of  it  could  be  found,  either  among  the  au- 
thor's papers,  or  in  the  State  of  Delaware. 


Biographical  Sketch.  xxiii 

In  the  year  1792,  the  Medical  Society  just 
mentioned,  among  other  measures  for  improving 
nudical  science,  and  meliorating  the  state  of  their 
profession,  proposed  as  a  prize-question, — "The 
"  origin  and  nature  of  that  noxious  power,  which, 
"  in  hot  and  moist  regions,  excites  intermitting 
"  and  remitting  fevers,  and  the  various  distempers 
"  which  prevail  during  summer  and  autumn  in 
"  such  situations  ;  the  mode  of  correcting  this 
"  infelicity  of  climate  ;  and  the  means  of  pre- 
"  venting  and  curing  the  maladies  thereby  in- 
duced?" This  question  was  announced  in  the 
Latin  language,  and  the  premium  offered  to  the 
successful  candidate,  was  three  hundred  dollars.* 

*  "  Omnibus  ad  quos  haec  pervenerint,  Salutem  : 

"  Quantum  medicinae  et  humani  generis  intersit,  morbos 
epidemicos,  in  regionibus  calidis  paludosis,  aestatis  et  autumni 
tempore,  grassantes  eorumque  causas  adhuc  usque  obscuras, 
plenius  explorare  et  detegere,  satis  novit  quisque  in  rebus  me- 
dicis  vel  minimum  versatus.  Magna  pais  orbis  terrarum, 
eaeque  pra;cipue  regiones,  quae  benignissimis  Divini  Numinis 
alioqui  replentur  muneribus,  hac  ex  causa  acerbissimis  aerum- 
nis  et  vastalionibiss  miserrimis  quotannis  objiciuntur.  Et  tu- 
to  fortasse  affirmari  possit,  ex  omnibus  moiborum  fontibus 
fere  nullum  esse,  hoc  longe  lateque  diffusiorem  vel  qui  ma- 
jora  corpori  humano  infert  mala. 

"  Argumentum  hocce,  medicorum  et  philosophorum  at- 
tentioni  vastam  et  fertilissimam  investigationis  provinciam 
ostendit,  ubi  tot  magni  nominis  viri  non  sine  Iaude  semet 
exercuerimt ;  sed  ubi  multura  adhuc  restat  operis,  multum- 


xx  iv  Biographical  Sketch. 

It  is  well  understood,  that  Doctor  Miller  was 
among  the  most  zealous  and  active  members  of 
the  Society  at  this  time  ;  that  he  was  of  the  num- 
ber of  those  who  prompted  and  aided   in  all  its 

que  diu  restabit ;  nee  unquam  fortasse  aliquid  indies  adjiei- 
endi  praecluditur  occasio.  Difficultates  quidem  imuique  pre- 
munt,  et  ad  lucem  rei  adeo  obscuroe  oifuudendam,  multis, 
iisque  accuratis  observationibus  et  ratiocinatione  cauta  ad- 
modum  et  sobria  opus  erit.  Suus  sic  quidem  cuique  labor 
erit,  sed  et  suae  simul  cuique  constabunt  bene  meritaj  laudes. 
Nequaquam  enim  est  fide  dignum,  naturam  tarn  arcto  limite 
ingenium  humanum  compescuisse,  ut  ad  has  quoque  regi- 
ones  utcunque  caecas  atque  occultas  viam  sibi  nunquam 
patefaciat. 

"  His  rebus  perpensis,  simulque  commodis  magnis  et  plu- 
rimis,  quae  ex  prsemiis  et  honoribus  publice  propositis  redun- 
dare  solent,  probe  consideratis,  Societas  Medica  Delavari- 
ensis,  symbolam  quoque  suam  ad  scientiae  acervum  confere 
cu[)iens,  qu83stionem  sequeutem  proponere,  et  auctorem  dis- 
sertationis  praistantissimie  prasmio  remunerare,  decreA  it. 

"  Quaznam  est  Potmtia  nocens,  ejwque  origo  atque  natiira, 
unde  in  regionibus  calidis,  iisdemque  humidis,  Inter mittentes 
oriuntur  Febres,  Remittentes  etiam,  variaqae  alia  mala,  quce 
cBstatis  et  autumni  tempore  grassari  solent  1  Qua,  ratione  hoc 
eo:li  vitiuni  corrigi  possit?  Quopacto,  quibusque  auxiliis  isti- 
usmodi  morbi  arceri  atque  tractari  debeant  ? 

"  Ex  iis  qui  praemium  illud  obtinere  cupiunt,  hoc  potissi- 
mum  et  necessario  exigitur,  ut  rationes  atque  auxiha  sedulo 
explorent,  quibus  hoc  coeli  vitium  facillime  corrigi  possit. 

"  Hujus  propositi  has  sunt  conditionep. 


Biographical  Sketch,  xxv 

laudable  enterprises ;  and  that  he  drew  up  with 
his  own  hand  the  Program  which  exhibited  the 
prize-question  above  mentioned.  No  answer  to 
this  question,  deemed  worthy  of  the  premium, 
was  ever  received. 

"  1.  Dissertationem  suam  Anglice,  Latine,  Gallice  aut  Ger- 
manice  conscriptam  mittendam  curabit  auctor  ad  Societa- 
tis  Praesidem,  in  diem  Martis  secundam  mensis  Maii,  anno 
1795. 

"  2.  Epistola  insuper  ab  auctore  mittenda  est,  nomen  suum 
domiciliique  locum  indicans,  eodemque  sigillo,  ac  ipsa 
dissertatio  munita,  cum  nota  etiam  qualibet,  parti  super- 
addita  exteriori,  qua;  alteram  dissertationi  praefixam  referat 

"  3.  Dissertatio  antea  evulgata,  aut  alibi  praemio  donata,  hoc 
digna  certamine  non  censebitur. 

"  4.  Dissertationem  praemio  donatam,  sub  quacunque  forma, 
jus  evulgandi,  penes  Societatem  esse,  semper  intelligent 
dum. 

"  5.  Nisi  autem  praestantissima  et  praemio  dignissima  dijudi- 
cata  fuerit  dissertatio,  ad  auctorem  quocunque  placuerit 
remitteretur,  una  cum  epistola  intacto  sigillo.  Vel  si  de 
hoc  parum  solicitus  fuerit  auctor,  epistola  comburetur,  et 
dissertatio  penes  Societatem  manebit. 

"  6.  Si  ex  dissertationibus  Societati  oblatis,  nulla  digna  ha- 
bebitur,  quae  tali  honore  condecoretur,  harum  auctores 
certo  sciant,  praemium  futurum  esse  nullum. 

H  7.  Praemium  ex  Thaleris  trecentis  (Anglice  Dollars)  vel  ex 

d 


xxvi  Biographical  Sketch. 

In  the  year  1793>  when  the  Yellow  Fever,  that 
frightful  disease,  which  has  since  made  so  much 
havoc  in  the  principal  cities  of  the  United  States, 
first  prevailed  to  any  alarming  extent  in  Philadel- 
phia, the  medical  controversy  respecting  its  origin, 
began  to  attract  general  attention  in  this  country. 
Doctor  Miller,  though  then  residing  in  Dover, 
and,  of  course,  considerably  removed  from  the 
centre  and  heat  of  the  battle,  was  by  no  means 
inattentive  to  its  nature  or  its  progress.  He,  at 
that  time,  from  the  best  comparison  of  testimony 
on  the  subject  which  he  was  able  to  make,  decided 
in  favour  of  the  doctrine  of  domestic  origin,  and 
wrote  a  long  and  interesting  Letter  to  Doctor 
Rush,  stating  his  views,  and  the  grounds  of  his 
opinion.  This  letter  was  afterwards  published  in 
most  of  the  American  newspapers,  and  drew  from 
the  illustrious  Man  to  whom  it  was  addressed, 
the  public  declaration,  that  he  considered  its  au- 
thor as  "  second  to  no  Physician  in  the  United 
States." 

argento  fusili  ejusdem  pretii  prout  auctori  visum  fuerit 
constabit,  quod  sibi  ipsi  vel  cuivis  amico  ex  ejus  mandato, 
intra  sex  menses,  dijudicatione  facta  memorabitur. 

"  Dabam  haec  ex  Societatis  jussu,  in  lucem  edita  Doverii 
apud  rempublicam  Delavariensem,  die  quarto  Julii  anno  Do- 
mini 1792. 

"  EDVARDUS  MILLER,  M.  D. 
Societatis  Sodalis,  ejusdemque  a 
Secretin." 


Biographical  Sketch.  xxvii 

It  was  in  the  year  1796,  that  Doctor  Miller 
removed  to  New-York.  It  is  with  mournful 
pleasure  that  the  writer  of  this  sketch  recollects 
his  own  agency  in  inducing  his  lamented  Brother 
to  make  this  removal.  The  malignant  epidemic 
of  1795,  had  removed  by  death  a  number  of  Physi- 
cians, whose  characters  were  respectable,  and  whose 
medical  practice  was  large.  At  the  close  of  that 
awful  visitation,  when  health  was  restored  to  the 
city,  and  when  new  plans  began  to  be  formed  to 
fill  up  the  chasms  which  death  and  desolation  had 
made,  the  writer,  then  residing  himself  in  the  city, 
began  to  turn  his  eyes  toward  a  Brother  whom  he 
tenderly  loved ;  whose  company  he  never  entered 
but  with  improvement ;  and  from  whom  he  had 
long  lamented  his  separation.  In  the  month  of 
November  of  that  year,  he  proposed  to  him,  and 
urged,  an  immediate  removal  to  New-  York.  Doc- 
tor Miller  received  the  proposal  in  the  most 
affectionate  manner  ;  but,  with  that  delicacy 
and  prudence,  for  which  he  was  always  remark- 
able, he  thought  himself  bound,  before  deciding, 
to  consult  such  members  of  the  Faculty  in  New- 
York  as  he  numbered  among  his  Friends.  He, 
accordingly,  addressed  letters  to  Doctor  John  R. 
B.  Bodgers,  and  Doctor  Mitchill,  on  this  subject, 
frankly  explaining  his  views,  and  soliciting  their 
judgment  in  the  case.  Their  replies  were  such 
as  might  have  been  expected  from  enlightened 
and  liberal  friends,  who  felt  disposed  to  encou- 


xxviii  Biographical  Sketch. 

rage  a  professional  brother.  He  determined  to 
make  the  experiment ;  immediately  entered  on 
the  adjustment  of  his  concerns  in  Dover ;  and 
in  the  month  of  September,  1796,  found  himself 
fixed  in  New-  York. 

His  success  in  this  city  was  much  greater,  and, 
particularly,  more  speedy,  than  he  had  anticipated. 
Among  the  many  practical  and  instructive  max- 
ims which  the  writer  of  these  pages  has  had  the 
privilege  of  receiving  from  the  lips  of  his  lament- 
ed Brother,  and  which  he  now  recollects  with 
mingled  emotions  ;  one,  often  repeated,  was,  that 
no  professional  man  can,  ordinarily,  expect  to  suc- 
ceed in  life,  without  obtaining  the  general  respect 
and  confidence  of  his  professional  brethren.  He 
thought  that  this  remark  applied  to  all  the  learned 
professions  with  peculiar  force  ;  that  Divines, 
Physicians,  and  Lawyers  are,  generally,  held  in  a 
degree  of  estimation  by  the  mass  of  their  fellow- 
citizens,  proportioned  to  the  degree  of  that  which 
they  enjoy  among  those  of  their  own  corps.  His 
own  character  and  history  certainly  went  to  the 
verification  of  this  maxim.  His  medical  brethren 
in  New-  York  soon  discovered  that  he  was  worthy 
of  their  confidence,  and  they  gave  it  to  him.  This 
itself  was  a  guarantee  of  a  considerable  portion  of 
professional  practice.  Accordingly  his  business 
soon  became  such  as  to  aiford  him  an  ample  sup- 


Biographical  Sketch.  xxix 

port ;  and  continued  to  become  more  and  more 
extensive  until  his  death. 

Soon  after  his  establishment  in  New-York, 
Doctor  Miller  became  a  member  of  a  literary  as- 
sociation, which  had  been  for  some  time  known 
to  those  who  participated  in  its  pleasures  and  ad- 
vantages, b)r  the  unostentatious  name  of  "  the 
Friendly  Club."  The  meetings  were  held  in  ro- 
tation at  the  respective  houses  of  the  members, 
on  the  Tuesday  evening  of  each  week.  Of  this 
association,  one  of  its  members  speaks  in  th^  fol- 
lowing terms.*  "  Never  was  a'place  of  appoint- 
ment, of  this  nature,  repaired  to  with  greater 
avidity,  or  the  pleasures  of  unshackled  intellectual 
intercourse  more  highly  enjoyed.  Ail  form  was 
rejected  by  the  "friendly  club,"  and  but  one 
rule  adopted,  which  was  that  the  member  who 
had  the  pleasure  of  receiving  his  friends  at  his 
house,  should  read  a  passage  from  some  author, 
by  way  of  leading  conversation  into  such  a  chan- 
nel as  might  turn  the  thoughts  of  the  company  to 
literary  discussion  or  critical  investigation.  This 
was,  for  the  greater  portion  of  the  time  it  existed, 
truly  a  "  friendly  club  ;"  but  after  a  continuation 
of  most  perfect  and  cordial  communion  for  a  few 
years,  the  demon,  whose  infuriated  and  blasting 
influence  is  unceasingly  exerted  to  mar  the  bles- 
sings of  our  envied  country,  party- politics,  found 

*  Monthly  Recorder,  vol.  I,  p.  8,  &c. 


xxx  Biographical  Sketch. 

his  way  among  the  "  friendly  club,"  and  the  in- 
stitution died  a  lingering  death.  Yet  I  believe  the 
surviving  members  feel  a  brotherly  affection  to- 
wards each  other,  and  a  regretful  remembrance  of 
those  days,  the  more  endearing  as  the  knowledge 
that  they  can  never  return  becomes  more  impres- 
sive, from  the  ravages  of  time  and  the  unsparing 
strokes  of  death." 

M  The  associates  of  Dr.  Miller  at  this  in- 
valuable period,  the  first  years  of  the  club,  were 
William  Dunlap,  then  manager  of  the  New- York 
theatre ;  James  Kent,  then  recorder  of  the  city, 
and  now  chief  justice  of  the  state  of  New-  York  ; 
Anthony  Bleecker,  attorney  and  counsellor  at  law 
and  master  in  chancery ;  Charles  Brockden  Brown, 
the  author  of  Wieland;  William  Walton  Woolsey ; 
Doctor  Elihu  Hubbard  Smith  ;  George  Muirson 
Woolsey ;  Doctor  Samuel  Latham  Mitchill;  John 
Wells,  attorney  and  counsellor  at  law ;  William 
Johnson,  attorney  and  counsellor  at  law,  and  re- 
porter to  the  supreme  court  of  the  state  of  New- 
York  ;  and  the  reverend  Samuel  Miller,  D.  D. 
Of  this  "  little  band,  this  band  of  brothers,"  Ed- 
ward Miller,  Elihu  Hubbard  Smith,  and  Charles 
Brockden  Brown  are  now  no  more." 

In  the  autumn  of  1796,  Doctor  Elihu  H.  Smith, 
(then  a  practitioner  of  medicine  residing  in  New- 
York,  and  a  man  whose  social  character  was  as 
amiable,  as  his  understanding  was  vigorous,  and 


Biographical  Sketch*  xxxi 

Ins  acquirements  rare,)  conceived  the  project  of  a 
Periodical  Publication,  to  embrace  medicine,  and 
all  the  departments  of  knowledge  connected  with 
it.  He  communicated  this  plan  to  his  friend, 
Doctor  Miller,  and  having  obtained  his  approba- 
tion of  it,  they  jointly  laid  their  design  before 
Doctor  Mitchill,  who  had  not  long  before  return- 
ed from  his  studies  and  travels  in  Europe,  and 
who  has  since  so  much  signalized  himself,  as  a 
friend  and  promoter  of  science,  and  as  a  member 
of  the  national  Legislature ;  requesting  him  to 
unite  with  them  in  the  execution  of  the  plan. 
The  failure  of  many  magazines,  and  other  period- 
ical publications  in  the  United  States,  and  the 
difficulty  of  circulating  such  works  in  a  country 
like  ours,  were  discouraging  circumstances  which 
did  not  fail  to  occur  in  deliberating  on  the  subject. 
There  was  reason  to  fear,  from  the  contemplation 
of  many  former  examples,  that  both  public  patron- 
age, and  materials  for  filling  the  pages  of  the  pro- 
jected work,  would  both  be  soon  exhausted.  But, 
notwithstanding  all  these  discouragements,  Doc- 
tor Mitchill  agreed  to  unite  with  his  friends,  and 
the  triumvirate  determined  to  proceed  in  the  en- 
terprise. About  the  middle  of  November,  in  the 
year  above  mentioned,  a  Circular  Address  was  laid 
before  the  literary  and  medical  public  of  the  Uni- 
ted States ;  and  the  plan  pursued  with  so  much 
vigour  and  success,  that,  in  the  beginning  of  Au- 
gust, 1797,  the  first  number  of  the  Medical 
Repository  made  its  appearance. 


xxxii  Biographical  Sketch. 

As  the  commencement  of  that  Publication  un- 
doubtedly forms  an  aera  in  the  literary  and  medical 
history  of  our  country,  it  may  not  be  improper  to 
lay  before  the  readers  of  the  present  volume,  en- 
tire, the  Circular  Address  which  ushered  in  the 
Medical  Repository,  and  which  was  followed  by 
so  large,  important  and  useful  a  work.  It  will 
probably  serve  to  give  those  who  shall  peruse  it, 
a  new  impression  of  the  enlarged  views,  the  ar- 
dent zeal,  and  the  active  industry  of  the  original 
Editors  of  that  work. 

"  After  a  continued  struggle  of  many  centuries, 
against  the  absurd  systems  of  ancient  physicians, 
and  amid  the  difficulties  repeatedly  opposed  to  the 
progress  of  Medicine  by  modern  hypotheses, 
scarcely  less  preposterous,  it  has  at  length  become 
established  as  a  fundamental  truth,  that  though 
conjecture  may  precede  experiment,  facts  are  the 
only  rational  basis  of  theory.  Philosophers  are  no 
longer  permitted  to  descend  from  generals  to  par- 
ticulars, shaping  them  according  to  preconceived 
notions  of  their  intimate  relations  ;  but  are  ex- 
pected to  proceed  by  a  rigid  examination  and  cau- 
tious assemblage  of  particulars  to  every  general 
inference.  This  laborious  process  of  reasoning, 
so  favourable  to  truth,  and  so  little  flattering  to  in- 
dolence, to  vanity,  and  to  a  creative  fancy,  requires 
the  possession  of  an  extensive  mass  of  experiment, 
a  various  and  judicious  selection  of  facts  ; — not 
only  for  him  who  would  overthrow  or  construct  a 


Biographical  Sketch.  xxxiii 

system,  but  for  every  one  who  would  rightly  ex- 
ercise the  art  to  which  they  belong.  And  in  pro- 
portion as  these  sentiments  have  gained  ground 
among  physicians,  systems  of  Physic  have  lost 
much  of  their  value  ;  and  Collections  of  Histories 
and  Observations,  whether  the  work  of  a  single, 
or  of  many  hands,  have  gradually  obtained  a  high 
consideration  and  authority  in  the  schools  of  medi- 
cine, as  well  as  in  the  closets  of  practitioners- 
For,  whatever  advantages  may  have  been  tem- 
porarily derived  from  certain  celebrated  theories, 
it  is  chiefly  by  the  new  spring  which  they  have 
given  to  the  mind,  and  by  the  more  accurate  in- 
vestigation of  natural  phenomena  to  which  they 
have  excited  others,  that  they  have  been  perma- 
nently useful.  Our  knowledge  of  nature  is  too 
limited,  our  collection  of  materials  too  scanty,  to 
enable  even  the  most  diligent  and  ingenious  to 
frame  a  correct  theory.  Medical  collections,  there- 
fore, are  still  necessary,  and  must  long  continue 
to  be  so  ;  and  as  they  are  free  from  the  incum- 
brance of  systematized  hypothesis,  the  opinions 
they  contain,  for  the  most  part,  spring  more  natu- 
rally out  of  the  facts  on  which  they  are  founded, 
are  thus  less  likely  to  mislead,  and  even  though 
erroneous,  as  they  maintain  no  intimate  connec- 
tion with  an  extensive  scheme,  still  leave  us,  in  the 
facts  themselves,  the  surest  guides  amidst  the  in- 
tricacies of  practice." 


xxxiv  Biographical  Sketch. 

"  Publications  of  this  kind,  likewise,  from  their 
very  nature,  possess  many  advantages  over  syste- 
matic works.  They  employ  a  greater  number  of 
observers,  over  a  wider  field,  admit  of  minuter  de- 
tails, ampler  discussions,  and  more  various  opin- 
ions and  recondite  investigations.  By  their  in- 
strumentality, facts  are  preserved  or  rescued  from 
oblivion,  which,  without  them,  had  been  wholly 
lost  :  for  there  are  few  men  who  find  leisure  and 
inclination,  from  the  pressure  of  daily  business,  to 
become  authors,  and  still  fewer  whose  observations 
are  so  numerous  and  important  as  to  demand  a 
laboured  treatise  ;  while  there  are  many  who  have 
time  and  facts  to  furnish  out,  almost  every  year  of 
their  lives,  a  short  but  valuable  essay.  And  if  to 
these  arguments,  in  favour  of  Medical  Collections, 
drawn  from  the  nature  of  the  works,  it  may  be 
permitted  to  add  others  from  the  practice  of  other 
nations  than  our  own,  the  example  of  almost  every 
civilized  country  of  Europe  may  be  cited;  in 
which  publications  of  this  kind  are  successfully 
multiplied,  and  sought  after  with  peculiar  avidity. 
But,  notwithstanding  the  many  obvious  benefits 
resulting  from  them,  such  undertakings,  in  the 
United  States,  have  been  few,  and  feebly  prose- 
cuted. And  this  is  the  more  to  be  lamented,  as 
no  country  in  the  world  is  so  capable  of  giving  per- 
manent utility  to  such  a  design.  For,  beside  those 
advantages  which  we  possess  in  common  with 
other  nations,  there  are  numerous  others  of  new 


Biographical  Sketch*  xxxv 

and  peculiar  importance.  These  exist  in  our  ex- 
tensive territory  ;  in  the  variety  of  its  soil,  cli- 
mate, elevation,  and  aspect ;  in  the  varied  de- 
scent, population,  intermixture,  institutions,  man- 
ners, and  consequent  diseases  of  its  inhabitants  ; 
in  the  opportunities  it  affords  of  observing  and 
estimating  the  effects  of  old  and  new  settlements, 
of  gradual  and  rapid  changes  in  the  face  of  a  coun- 
try, of  agriculture,  commerce,  and  navigation,  of 
the  savage,  civilized,  and  intermediate  states  of  so- 
ciety ;  of  comparing  the  diseases  or  phenomena,  of 
each  disease,  and  the  operation  of  the  same  reme- 
dies, in  the  same  or  different  complaints,  in  Eu- 
rope and  America  ;  in  the  general  diffusion  of 
knowledge,  and  turn  for  observation,  among  all 
classes  of  its  citizens  ;  and,  finally,  in  the  same- 
ness and  perfection  of  their  language — an  advan- 
tage possessed  in  the  same  degree  by  no  other 
people. — These  are  privileges  which  should  prove 
so  many  powerful  incentives  to  medical  industry  ; 
which  should  inspirit  the  exertions  of  physicians 
to  give  that  importance,  in  a  professional  view,  to 
their  country,  which,  fertile  as  she  is  in  occasions, 
she  loudly  calls  for  at  their  hands." 

"  The  present  time  seems  particularly  favour- 
able to  such  attempts.  The  distressing  events 
which  have  been  so  recently  witnessed,  in  various 
parts  of  our  country,  have  awakened  the  curiosity 
of  others,  as  well  as  of  physicians  ;  and  while  they 


xxxvi  Biographical  Sketch, 

have  quickened  the  zeal  and  observation  of  the 
latter,  have  excited  the  eager  apprehensions  of  all. 
This  has  created  an  uncommon  interest,  in  res- 
pect to  medical  opinions,  among  the  people  at 
large,  and  especially  since  the  belief  of  the  domes- 
tic origin  of  certain  diseases  has  been  considerably 
disseminated.  The  partial  success  of  a  late  be- 
nevoient  attempt,  of  the  kind  now  referred  to,*  is 
rather  encouraging  than  disheartening  ;  since  its 
failure  is  attributable  to  causes  not  necessarily  con- 
nected with  the  design,  and  since  there  is  good 
ground  to  believe,  that  a  little  perseverance  would 
have  given  it  stability  and  reputation. — To  the 
success  of  such  a  publication,  much  time,  as  well 
as  the  concurrent  exertions  of  many  observers, 
were  indispensable.  The  held  of  inquiry,  like- 
wise, was  comparatively  narrow  ;  and  too  much 
reliance  was,  probably,  placed  on  public  solicita- 
tion, with  so  limited  a  time  for  the  collection  of 
materials," 

°  Influenced  by  considerations,  and  invited  by 
views,  which  we  have  now  unfolded,  and  shall 
consequently  enlarge  upon,  we  have  ventured  to 
project  a  work  such  as  we  have  recommended, 
and  thus  publicly  to  solicit  your  assistance  in  its 
execution.  And  we  request  you  to  furnish  us, 
either  quarterly,   semi-annually,   or  annually,  as 

x  Mr.  Webster's  Collection,  relative  to  Bilious  Fevers,  &e 


Biographical  Sketch.  xxxvii 

may  best  suit  with  your  convenience,  with  such 
information,  relative  to  all  or  either  of  the  follow- 
ing particulars,  as  may  be  in  your  power. 

"  1.  Histories  of  such  diseases  as  reign  in  your 
particular  places  of  residence,  at  each  and  eve- 
ry season  of  the  year  ;  including  the  time  of 
their  appearance  and  disappearance  ;  the  pecu- 
liar customs  and  manners,  and  food  of  the 
people  ;  local  peculiarities,  (not  merely  those 
of  the  town  or  village,  but  of  the  immediate 
residence  of  the  sick,)  preceding,  contempo- 
rary, and  subsequent  complaints  ;  symptoms, 
progress,  extent,  method  of  cure,  mortality, 
and  what  proportion  of  either  sex,  and  of  dif- 
ferent ages,  are  affected  : — in  sea-ports,  atten- 
tion to  be  paid  to  supposed  sources  of  impor- 
tation, and  to  the  arrival  of  foreigners  ;  in  new 
settlements,  to  changes  in  the  face  of  the 
country,  by  clearings,  drainings,  &c.  and  to 
the  increase  of  population,  by  emigration  and 
otherwise." 

"  2.  Histories  of  such  diseases  as  appear  among 
Domestic  Animals — such  as  horses,  cattle, 
sheep,  &x. — their  causes,  symptoms,  method 
of  cure,  &x.  &c." 

"  3.  Accounts  of  Insects — whether  any  uncom- 
mon dearth  or  numbers  of  them ;  whether 


xxxviii  Biographical  Sketch, 

troublesome  or  noxious  to  men,  beasts,  or 
vegetables  ;  with  as  accurate  and  minute  no- 
tices as  may  be  of  their  derivation,  mode  of 
propagation,  nature  and  extent  of  such  rav- 
ages, or  other  evils,  as  they  may  occasion  ;  of 
their  appearance  and  disappearance,  and  of  the 
means,  if  any,  of  guarding  against  or  destroy- 
ing them." 

"  4.  Histories  of  the  progress  and  condition  of 
Vegetation — with  regard  to  growth,  vigour, 
and  disease  ;  independent  of  the  ravages  of 
insects  ;  but  marking  the  influence  of  ma- 
nures, and  the  local  situation,  both  as  to  ele- 
vation and  soil,  air  and  water." 

"  5.  The  state  of  the  Atmosphere — in  respect  to 
dryness  and  humidity,  heat  and  cold,  serenity 
and  tempestuousness  ;  including  the  direction 
and  force  of  winds,  and  the  sensible  quantity 
of  electricity." 

"  Where  information  relative  to  these  various 
topics  of  inquiry  can  be  given  in  a  connected  form, 
it  will  be  most  acceptable  ;  and  the  more  minute 
and  precise,  the  more  useful  will  it  be.  But  gene- 
ral and  distinct  communications  are  earnestly  re- 
quested, where  more  extensive  and  combined  in- 
telligence cannot  readily  be  afforded." 


Biographical  Sketch.  xxxix 

"  The  outline  now  traced,  gentlemen,  will  ena- 
ble you  to  form  some  idea  of  the  nature,  extent, 
and  importance  of  the  work,  in  the  prosecution  of 
which  we  solicit  your  co-operation.  The  benefits 
which  may  result  from  such  a  publication,  if  vi- 
gorously and  judiciously  executed,  are  too  nume- 
rous and  considerable  not  to  be  suggested  by  the 
slightest  reflection.  Were  it  to  be  ably  and  com- 
pletely prosecuted,  it  could  scarcely  fail,  even  in 
a  few  years,  of  leading  us  to  a  near  view  of  the 
origin  and  causes  of  general,  or  febrile  diseases  ; 
to  the  discovery  of  what  situations,  climates,  and 
seasons,  most  favoured  their  production  ;  of  the 
order  and  rapidity  of  their  progression,  from  one 
place  to  another,  in  the  same  or  different  coun- 
tries ;  and  of  the  most  successful  method  of  cure, 
as  well  as  of  prevention.  Aided  by  a  work  com- 
posed of  materials  collected  with  such  care,  and 
drawn  from  so  many  and  so  distant  quarters,  we 
might  be  enabled  to  determine  the  relative  healthi- 
ness of  places ;  the  causes  why  some  were  favour- 
able and  some  unfavourable  to  health  ;  their  pecu- 
liar diseases,  with  the  means  of  their  removal  and 
extirpation. — No  plan  seems  more  happily  cal- 
culated to  mark  and  explain  the  influence  of  dif- 
ferent states  of  society,  occupations,  institutions, 
manners,  exposure,  air,  modes  of  living,  &c.  &c. 
on  health  ;  and  thus,  indirectly,  on  morals,  in- 
dustry, and  happiness  :  none  more  happily,  for 
resolving  the  hitherto  unexplained  and  difficult 


xl  biographical  Sketch. 

problem,  proposed  by  the  illustrious  Syden- 
ham ,* — "  whether  a  careful  examination  might 
"  not  shew,  that  certain  tribes  of  disorders  con- 
"  stantly  follow  others,  in  one  determinate  series, 
"  or  circle,  as  it  were  ;  or  whether  they  all  return, 
"  indiscriminately,  according  to  the  secret  dis- 
"  position  of  the  air,  and  the  inexplicable  succes- 
"  sion  of  the  seasons."  Nor  is  the  solution  of  this 
problem  of  small  importance  ;  since,  in  the  first 
place,  were  it  discovered  that  general  diseases 
pursued  a  regular  course,  we  might  thence  be 
prepared  to  receive  and  counteract  them  ;  or, 
were  it  determined  that  they  depended  on  the 
qualities  of  the  atmosphere,  we  should  be  directed 
to  the  proper  object  of  investigation,  and  thus 
be  well  advanced  towards  a  knowledge  of  their 
causes.  But,  whatever  may  be  true  in  res- 
pect to  the  systematic  succession  of  diseases, 
hinted  at  by  Sydenliam,  it  is  certain  that  an 
apparent  progress  of  a  particular  disease  has 
sometimes  been  observable  in  the  United  States  ; 
as  though  the  morbid  principle  possessed  the  pow- 
er of  assimilating  the  atmosphere  to  its  own 
nature,  agreeable  to  determinate,  but  inscrutable 
and  peculiar  laws  :  sometimes  rapidly  extending, 
as  in  the  Infaienza  ;  sometimes  slowly,  as  in  Scar- 
latina. It  is  perhaps  difficult  rightly  to  appreciate 
the  benefits   which  the  determining  of  a  single 

*  Wall!^  S vdenhani,  vol.  i.  p.  6. 


Biographical  Sketch.  kli 

point  like  this  would  confer  on  medicine  ;  f  whether 
by  quieting  apprehensions  of  such  an  extension  of 
a  disease,  if  indeed  there  were  no  reason  to  fear 
it  ;  or  by  putting  us  on  our  guard,  if  such  were 
clearly  proved  to  be  its  nature)— <  but,  whatever 
they  may  be,  no  method  seems  better  adapted 
for  ascertaining  the  fact,  than  by  a  publication 
like  the  one  now  proposed.  By  this  means,  the 
inquirer  will  be  presented  with  a  regular  history 
of  the  progress  of  such  a  disease,  from  one  ex- 
tremity of  the  continent  to  the  other  ;  and  be  able 
to  mark  its  effects  in  all  the  varieties  of  people* 
climate,  and  season  ;  or,  if  it  appear  in  several  pla- 
ces, obviously  disconnected,  at  the  same  time,  of 
comparing  the  circumstances  in  which  they  re- 
semble each  other,  and  thus  of  determining  its 
causes. — But,  not  to  dwell  longer  on  the  reconu 
mendations  to  such  a  work,  we  may  ultimately 
remark,  that,  when  thus  completed,  the  volume 
of  every  year  will  form  the  history  of  the  health 
of  the  United  States  for  the  year  preceding :  a  sin- 
gle glance  of  the  eye  will  be  equal  to  perceive 
what  diseases  prevailed  at  the  same  time,  in  all 
the  intermediate  situations,  from  St.  Mary's  to  St. 
Croix,  and  from  the  Mississippi  to  the  Atlantic; 
and  individual  experience*  as  well  as  new  discov- 
eries, will  be  propagated  with  unexampled  benefit 
and  celerity,  to  every  part  of  the  United  States/' 

"  When  we  consider  the  extensive  plan  now 
f 


xlii  Biographical  Sketch. 

proposed,  the  number  of  persons,  and  the  time 
required  for  its  execution,  and  the  'difficulties 
which  always  attend  every  work  of  the  kind,  we 
should  indulge  a  presumptuous  and  reprehensible 
expectation,  did  we  look  to  see  it  speedily  and 
completely  carried  into  effect.  But,  notwithstand- 
ing all  reasonable  allowance  for  impediments  of 
this  sort,  we  flatter  ourselves  that  such  materials 
may  be  collected,  from  time  to  time,  as  will  enable 
us  to  present  annually  an  acceptable  volume  to  the 
public  ;  while  the  great  object  of  our  proposed 
inquiries,  as  already  explained,  will  gradually  ac- 
quire consistence  and  patronage." 

"  To  the  end  that  such  a  volume  may  be  readily 
and  regularly  published,  we  have  thought  it  advi- 
sable to  add  the  following  subjects,  to  those  alrea- 
dy proposed,  concerning  all  of  which  we  would 
request  information." 

11 1.  Accurate  and  succinct  accounts  of  the  gene- 
ral diseases  which  have  formerly  prevailed  in 
any  part  of  the  United  States." 

"2.  Useful  histories  of  particular  Cases." 

"3.  Histories  of  such  complaints  of  professional 
men,  mechanics,  manufacturers,  &c.  as  appear 
to  originate  from  their  peculiar  employments, 
or  the  materials  with,  or  about  which  they  are 
employed." 


Biographical  Sketch.  xliii 

"  4.  New  methods  of  curing  diseases." 

*  5.  Accounts  of  new-discovered  or  applied ,  re- 
medies,  in  rare  or  hitherto  incurable  diseases." 

"  6.  Extracts  from  rare,  printed  or  manuscript, 
works,  illustrative  of  the  nature  and  cure  of 
such  diseases  as  now  prevail  in  the  United 
'  States." 

"  7.  Interesting  information,  relative  to  the  mine- 
rals, plants,  and  animals  of  America/* 

"8.  American  medical  biography." 

"9.  Accounts  of  former  American  medical  pub- 
lications." 

"  10.  Reviews  of  new  American  medical  publi- 
cations." 

"  11.  Medical  news." 

"  It  will  be  obvious  to  every  one,  that  the  vari- 
ety of  subjects  comprehended  in  this  undertaking, 
will  put  it  in  the  power  of  almost  every  other  class 
of  citizens,  as  well  as  of  physicians,  usefully  to  aid 
in  its  execution :  and  as  the  benefits  which  may 
result  from  its  success  are  limited  to  no  descrip- 
tion of  men,  we  are  the  more  encouraged  to  solicit 


xiiv  Biographical  Sketch. 

assistance  from  all  whose  situations  enable  them 
to  afford  it.  We  address  ourselves,  therefore,  not 
to  physicians  only,  but  to  men  of  observation,  and 
to  the  learned,  throughout  the  United  States." 

"  With  respect  to  the  mode  of  publication,  we 
have  not  yet  decided,  whether  to  print  an  octavo 
volume  annually,  or  to  distribute  the  same  mate- 
rials into  four  quarterly  numbers,  equal  to  such  a 
volume.  This  must  be  determined,  in  good 
measure,  by  the  regularity  and  readiness  with 
which  we  are  supplied  with  suitable  materials  : 
and  by  those  superior  advantages  for  circulation 
which,  after  proper  inquiry,  one  form  shall  appear 
to  possess  over  the  other.  But,  whichever  may 
be  preferred,  seasonable  notice  will  be  given,  and 
a  subscription  will  be  opened  to  defray  the  ex- 
pense, when  we  are  ready  for  publication  ;  and,  in 
the  mean  time,  it  is  desired  that  all  communica- 
tions may  be  addressed  to" 

"  Samuel  L.  Mitchill." 
•'  Edward  Miller." 
"  E.  H.  Smith." 
«  New-York,  Nov.  15th,  1796." 

This  appeal  to  the  good  sense  of  the  medical 
profession,  and  to  the  patronage  of  the  public, 
was  not  made  in  vain.  It  was  the  forerunner  of  a 
Work  which  has  continued  for  sixteen  years,  and 
consists  of  as  many  annual  volumes.      Doctor 


Biographical  Sketch*  xlv 

Miller  lived  to  see  the  59th  quarter-yearly  num- 
ber in  the  press  ;  or,  in  other  words,  to  see  four- 
teen volumes,  and  three-fourths  of  the  fifteenth, 
completed. 

This  work  consists  of  Jour  departments.  The 
first,  embraces  Original  Tracts  or  memoirs,  on 
medical  subjects,  or  the  auxiliary  branches  of 
science.  The  second,  Reviews  of  such  publica- 
tions as  come  within  the  province  assigned  to 
themselves  by  the  Editors,  The  third,  Medical 
and  Philosophical  Intelligence.  And  the  fourth, 
which  was  only  occasionally  subjoined,  was  a  sup- 
plement, or  appendix,  containing  such  papers  and 
tracts,  not  original,  as  were  deemed  worthy  of  a 
place  on  account  of  their  intrinsic  merit,  and  the 
danger  of  their  being  lost  on  the  diurnal  sheets  of 
the  times. 

The  contributions  to  the  pages  of  this  work, 
from  all  quarters,  were  unexpectedly  liberal.  The 
diligence  of  the  conductors  was  incessant  and  un- 
wearied. From  all  sources,  foreign  and  domestic, 
they  gathered  materials.  These  accumulated  un- 
der their  hands  to  an  exuberant  amount :  inso- 
much that,  if  the  Editors  had  thought  proper,  the 
Medical  Repository  might  have  been  continued 
purely  as  an  American  Journal,  without  borrow- 
ing even  a  paragraph  from  any  transatlantic  pub- 
lication.    But  as  their  object  was  the  promotion 


xlvi  Biographical  Sketch. 

of  general  science,  and  especially  the  diffusion  of 
every  thing  connected  with  medical  improve- 
ment, from  whatever  quarter  it  might  be  derived, 
throughout  the  States  and  Territories  of  North- 
America,  they  freely  selected,  from  the  foreign 
prints,  such  articles  as,  from  their  novelty  and 
interest,  most  deserved  attention.  Their  zeal  in 
establishing  an  extensive  correspondence,  and 
their  success  in  obtaining  early  intelligence,  were 
remarkable.  As  an  example  of  this,  it  may  be 
stated,  that  Dr.  Jennets  first  publication  on  the 
Cow-pox  was  announced  in  the  Medical  Reposi- 
toi  y  in  a  few  w^eeks  after  its  appearance  in  Great 
Br i tain  ;  and  in  a  short  time  afterwards  the  vac- 
cine matter  was  received  by  Doctor  Miller,  from 
his  correspondent,  Doctor  Pearson,  of  London, 
and  introduced  into  Nexv- York. 

The  Medical  Repository,  thus  constituted,  and 
so  long  continued,  is,  in  fact,  a  medical  library, 
winch  every  student  and  practitioner  of  medicine, 
and,  indeed,  every  man  of  liberal  curiosity  in  the 
United  States,  ought  to  possess.  It  comprehends 
the  history  of  the  endemic  and  epidemic  diseases 
of  our  country,  especially  of  that  dreadful  scourge 
of  our  principal  cities,  from  1793  to  1806,  the 
Yellow  Fever.  It  records  all  important  discove- 
ries in  Natural  History.  It  notices,  with  parti- 
cular care,  Physical  Geography,  in  its  curious 
and  useful  progress.     It  exhibits  the  discoveries 


Biographical  Sketch.  xlvii 

and  revolutions  in  Chemistry,  with  minute  ex- 
actness. To  all  these  are  added,  articles  almost 
numberless,  of  inquiry  and  intelligence,  on  every 
subject  allied  to  the  great  departments  before  sta- 
ted. In  short,  it  may  be  considered  as  a  faithful 
record  of  every  discovery  and  improvement  in 
medicine,  and  the  auxiliary  branches  of  science, 
and  of  every  American  work  on  these  subjects, 
which  the  Editors  deemed  worthy  of  notice,  for 
the  last  sixteen  years.  If  the  fastidious  critic  is 
sometimes  ready  to  smile  at  the  introduction  of 
some  articles,  which  do  not  seem  appropriately  to 
belong  to  such  a  work,  he  will  find  a  ready  apo- 
logy, in  the  considerations,  that  we  live  in  a  coun- 
try in  which,  from  the  extent,  and  spareness  of 
its  population,  the  circulation  of  many  periodical 
works  is  difficult ;  that  a  variety  of  tastes  are  to 
be  consulted  ;  and  that  the  division  of  literary  la- 
bour has  not  yet  made  such  progress  in  the  Uni- 
ted States,  as  may  be  expected  in  time  to  come. 

From  this  work,  as  a  parent  stock,  have  sprung 
a  number  of  works,  of  a  similar  kind,  in  Europe 
and  America.  It  is  not  recollected,  by  the  writer 
of  these  sheets,  that  any  periodical  publication, 
devoted  to  medicine  and  medical  philosophy,  that 
could  be  said  to  be  of  the  same  nature  with  the 
Medical  Repository,  had  ever  before  appeared. 
The  Aledical  Commentaries,  of  Professor  Duncan, 
of  Edinburgh,  were,  in  many  respects,  very  dif- 


xlviii  Biographical  Sketch. 

ferent.  The  Medical  and  Physical  Journal,  of 
London,  was  commenced  soon  after  the  appear* 
ance  of  the  Medical  Repository,  with  the  avowal 
of  its  Editor,  that  he  took  the  hint  from  New- 
York.  Other  editors  in  London,  Paris,  Edin- 
burgh, and  Bremen,  in  a  short  time  started  similar 
journals  ;  while  rival  and  learned  publishers  in 
New-York,  Philadelphia,  Baltimore  and  Boston, 
have  been  excited  to  exertions  of  the  most  respect- 
able kind,  from  which  there  is  no  doubt  that 
highly  valuable  results  have  accrued.  To  the 
Medical  Repository,  it  may  be  said  to  be  directly 
or  indirectly  owing,  that  the  physicians  of  the 
United  States  have  been  so  early  and  so  exten- 
sively combined  into  a  corps  of  observers  and 
Avriters,  on  subjects  appropriated  to  their  profes- 
sion ;  that  many  respectable  practitioners,  have 
been  prompted  to  inquiries  and  publications  of 
great  value,  which  would,  probably,  never  have 
been  thought  of,  but  for  this  Work  and  its  literary 
offspring  ;  and  that  a  taste  for  medical  investiga- 
tion and  improvement  has  been,  for  a  number  of 
years  past,  so  conspicuously  and  rapidly  advancing 
in  the  United  States. 

Dr.  Miller  was  of  the  opinion  that  there  is  no 
science  in  which  America  has  made  more  progress 
than  that  of  medicine,  and  none  in  which  she 
holds  a  more  complete  independence  of  the  Eu- 
ropean world.     It  is,  indeed,  true,  that  the  physi- 


Biographical  Sketch.  xfrx 

Sians  of  this  country  were  originally  indebted  to 
their  preceptors  in  Europe,  for  the  elements  of 
most  of  that  knowledge,  which  they  have  since  so 
successfully  laboured  to  simplify,  improve  and 
extend.  It  was  natural  to  suppose,  as  so  many 
of  the  most  distinguished  members  of  this  pro- 
fession had  received  their  education  beyond  the 
Atlantic,  that  they  would  remain  fixed  in  the. 
trammels  of  earlv  instruction,  and  refuse  to  listen 
even  to  the  evidence  of  facts,  when  found  not  to 
coincide  with  the  principles  which  they  had  deep- 
ly  imbibed.  Much  of  this  implicit  reliance  upon 
transatlantic  authority  has,  doubtless,  been  ob* 
served ;  but  it  is  equally  true  that  America  may 
boast  of  much  free  inquiry,  and  of  much  bold  and 
successful  improvement.  This  hemisphere  is  the 
theatre  on  which  the  prejudices  and  errors  of  the 
European  schools,  in  a  great  variety  of  instances, 
have  been  refuted  and  abandoned,  and  on  which 
new  principles  in  medicine  have  been  proposed, 
ascertained,  and  completely  established.  In  sup* 
port  of  this  assertion  it  would  be  easy  to  adduce 
not  only  the  facts  concerning  American  physi- 
cians who  have  been  educated  in  Europe,  and  re- 
turned to  their  native  country ;  but  those,  like- 
wise, of  European  physicians  going,  in  various 
capacities,  to  reside  in  the  West- Indies.  Are' 
diseases  on  this  side  of  the  globe  more  gigantic 
in  their  nature,  more  marked  and  incapable  of 
disguise  in  their  features,  than  in  the  land  of  our 

£ 


1  Biographical  Sketch. 

ancestors  ?  or  to  what  else  are  we  to  attribute  this 
effect? 

It  would  exceed  the  proper  limits  of  this  di- 
gression, and  would  appear  unbecoming  in  the 
writer,  who  has  no  claims  to  medical  science, 
were  he  to  enter  into  any  discussion  of  the  con- 
flicting opinions  of  American  and  European  phy- 
sicians, or  of  American  physicians  among  them- 
selves. But  he  has  been  accustomed  often  to 
hear  One,  who  was  by  no  means  an  inactive  mem- 
ber of  that  profession,  and  who  was  far  from  being 
a  careless  observer,  express  himself  so  strongly 
concerning  American  enterprise  and  improve- 
ments in  medicine,  that  he  cannot  forbear  curso- 
rily to  state  his  views  of  the  subject. 

He  thought  that  medical  science  in  America 
might  justly  claim  the  merit  of  real  discoveries, 
and  solid  improvements  in  the  following  particu- 
lars. A  more  simple  and  correct  doctrine  con- 
cerning the  radical  and  universal  relations  of  dis- 
eases. A  more  rational  and  practical  estimate  of 
Nosology,  the  importance  of  which  he  thought  had 
been  greatly  overrated  in  Europe.  More  just,  ac- 
curate and  consistent  opinions  concerning  the  ori- 
gin and  causes  of  epidemic  and  pestilential  dis- 
eases ;  according  to  which  the  notions  of  their 
importation  and  exportation  from  one  country  to 
another  are  rejected,  and  the  doctrine  of  their  do- 


Biographical  Sketch.  li 

mestic  origin  satisfactorily  established.  More  cor- 
rect principles  on  the  subject  of  quarantine,  which 
might  diminish  the  restrictions  and  burdens  of 
commerce,  and  render  the  intercourse  of  nations 
more  hospitable  and  humane.  And  a  more  ex- 
tensive acquaintance  with  the  medicinal  virtues 
and  uses  of  many  articles  of  the  vegetable  king- 
dom. 

Among  many  particular  diseases  and  remedies, 
the  management  of  which  has  been  improved  in 
the  United  States,  he  thought  the  following  might 
be  selected  with  great  confidence.     A  more  sim- 
ple and  efficacious  treatment  of  Malignant  Fevers; 
a  more  correct  theory  and  practice  in  Dropsy, 
particularly  in  that  of  the  Brain  ;  a  more  discri- 
minating, decisive,  and  successful  employment  of 
Bloodletting  in  fevers  ;  and  a  more  extensive  and 
efficacious  use  of  Mercury  in  a  variety  of  diseases. 
It  need  scarcely  be  added,  that,  to  a  mind  so  emi- 
nently patriotic  as  his,  and  with  so  ardent  a  zeal 
as  that   which   he  possessed  in  favour  of  every 
thing  which  had  the  aspect  of  improvement  in  the 
arts  and  sciences,  and  especially  in  that  science  to 
which  he  was  more  particularly  devoted,  the  en- 
terprise and  progress   in  this  science  which  he 
thought  he  discovered  in  his  own  country,  were 
peculiarly  gratifying ;  and  that  he  was  animated 
with  the  thought  of  contributing  himself,  in  some 


lii  Biographical  Sketch. 

degree  toward  the  advancement  of  so  interesting  w 
cause. 

But  to  return  to  the  Medical  Repository. 
That  the  Editors,  in  their  long- continued  and  in- 
defatigable labours  in  carrying  on  this  publication, 
were  actuated,  not  by  mercenary  motives,  but  by 
a  laudable  zeal  for  public  and  professional  im- 
provement, will  appear  from  the  fact,  that  none 
of  them  ever  received  the  smallest  emolument 
from  the  work.  They  devoted  their  time  and 
talents  to  the  good  of  the  cause  in  which  they  en- 
gaged ;  and,  to  employ  the  significant  language  of 
the  learned  Survivor,  besides  some  charges  of  a 
seriously  expensive  kind,  which  were  unavoidably 
connected  with  their  editorial  character,  "  they 
"  literally  worked  for  nothing,  and  found  them- 
"  selves."  May  the  present  editors  labour  with 
better  remuneration  in  time  to  come  !  and  may 
the  work  long  continue  a  monument  of  the  zeal, 
the  liberality,  and  the  improvement  of  American 
physicians  ! 

In  August,  1798,  the  "  American  Mineralo- 
gical  Society,"  of  which  Doctor  Miller  was  an 
active  member,  endeavoured  to  exciie  the  public, 
attention  to  that  important  department  of  science 
to  which  their  title  refers.  It  was  gratifying  to 
see  a  set  of  gentlemen,  when  the  dreadful  pesti- 
lence of  that  memorable  season  had  actually  be- 


Biographical  Sketch.  liii 

gun,  and  when  the  agitation  and  terror  which  its 
ravages  produced,  were  beginning  to  be  felt,  di- 
recting their  attention,  with  so  much  ardour,  to 
objects  of  public  and  national  interest.  The  fol- 
lowing Address  to  the  public  from  a  committee  of 
that  society,  of  which  Doctor  Miller  was  one,  is 
inserted,  as  well  because  it  is  believed  he  had 
some  concern  in  drafting  it,  as  because  it  will  af- 
ford another  proof  that  he  and  his  associates  were 
animated  by  those  sentiments  of  zeal  for  the  pro- 
motion of  science,  and  of  ardent  patriotism,  which 
eannot  be  too  highly  commended. 

"The  Committee  of  the  American  Miner  a- 
logical  Society  have  lately  published  an  ad- 
vertisement, the  object  of  which  was  to  collect 
into  one  view  all  the  information  that  is  scattered 
through  the  Union,  relative  to  the  means  our  coun- 
try possesses  of  furnishing  objects  immediately 
requisite  for  national  defence.  They  now  take 
the  liberty  of  offering  some  remarks  to  their  fel- 
low-citizens, upon  the  more  general  objects  of 
their  institution,  and  the  means  of  improving  the* 
science  it  is  intended  to  cultivate.1' 

"  If  the  bowels  of  the  earth  had  furnished  no 
riches  but  gold  and  silver,  it  were  better,  perhaps, 
that  the  hands  of  men  had  never  penetrated  them. 
But  when  we  remember  that  iron,  the  parent  of 
arts  and  of  civilization  ;  that  mercury,  so  useful  in 


liv  Biographical  Sketch. 

experimental  philosophy,  medicine  and  the  arts  ; 
and  that  sea-coal,   the  load-stone,  and  so  many 
other  objects,   without  which  society  could  not 
exist  in  its  present  state,  are  the  fruits  of  mineral 
labours,  we  shall  be  convinced  that  the  world  is 
almost  as   much  indebted  to  the   interior  of  the 
earth  for  improvements,  as  to  its  surface  for  sub- 
sistence.    Mineral  substances  enter,  directly  or 
indirectly  into  almost  every  manufacture,  whether 
of  objects  ornamental  or  useful.    Glass,  porcelain, 
gunpowder,  certain  of  the  most  powerful  acids, 
some  of  the  most  elegant  and  permanent  of  our 
colours  and  clycs,  and  the  most  powerful  class  of 
remedies  known  to  the  medical  art,  are  chiefly  of 
this  class.     How  various  are  the  forms,  and  how 
multiplied  are  the  uses,  of  the  instruments  that 
art   has  made  from   the  perfect   and   imperfect 
metals  !   Some  of  these  by  their  strength  and  du- 
rability, are  formed  to  apply  or  to  resist  the  utmost 
efforts  of  mechanic  power.     Some  that  are  equal- 
ly durable  yield  pliably  to  the  hand  of  art,  and  as- 
sume, with  readiness,  whatever  forms  convenience 
dictates.     There  are  those  that  are  ductile  almost 
beyond  our  conception,  and  that  receive  a  polish, 
which  is  proof  against  the  ravages  of  time.    Some 
yield  readily  to  the    heat  of  the  furnace,  while 
others  defy  the  attacks  of  artificial  fire.    The  me- 
tals, by  their  different  degrees  of  strength,  elasti- 
city, durability,  weight  and  incorruptibility,   and 
other  mineral  substances,  by  the  still  greater  num- 


Biographical  Sketch.  lv 

ber  and  importance  of  their  qualities,  are  fitted 
for  uses  as  various  as  the  imaginations  of  men, 
aud  as  important  as  their  wants." 

"  A  nation  which  is  deficient  either  in  mineral 
riches,  or  in  a  knowledge  of  them,  is  wanting  in 
the  most  essential  requisites  of  political  and  com- 
mercial independence.  The  United  States  have 
been  liitic  explored  ;  but  they  have  given  indica- 
tions of  possessing  objects  to  reward  the  researches 
of  the  mineralogist  in  greater  abundance  than  most 
other  countries.  They  contain  vast  chains  of  original 
mountains — vast  tracts  of  country — of  a  secondary 
and  of  an  alluvial  formation — extensive  plains, 
once  the  beds  of  lakes,  and  mountains  broken  to 
their  centre  by  the  convulsions  of  nature — it  can 
hardly  happen,  in  the  course  of  things,  that  such 
a  country  should  not  be  abundant  in  mineral 
resources." 

"  The  discovery  and  improvement  of  these  re- 
sources  generally,  is  the  object  towards  which  the 
society  wishes  to  direct  its  labours.  It  is  hoped 
and  believed  that  every  description  of  citizens 
will  be  inclined,  as  occasion  shall  offer,  to  aid  the 
undertaking.  The  owners  of  land  will  gladly  as- 
sist in  making  discoveries  which  may  enhance  the 
value  of  their  estates  ;  the  actual  cultivator  of  his 
farm  will  find  an  interest  in  the  discovery  of  marls, 
clavs,  chalk-beds,  and  whatever  else  may  be  use^ 


lvi  Biographical  Sketch. 

lul  for  manure  ;  the  man  of  leisure,  if  such  there 
be  in  America,  will  find  an  elegant  amusement  in 
the  collection  of  a  cabinet,  and  the  man  of  science 
an  interesting  employment  in  the  study  of  it." 

"  Encouraged  by  these  reflections,  the  society 
beg  leave  to  mention  to  their  fellow-citizens  some 
ideas  relative  to  the  means  of  improving  the  know- 
ledge of  mineralogy  in  this  country,  with  little  ex- 
pense or  labour.  They  suggest  the  following- 
ideas,  and,  at  the  same  time,  are  ready  to  consider, 
with  due  attention,  any  different  ideas  that  may 
be  suggested  by  others." 

"  1st.  Societies  might  be  formed  in  different 
parts  of  the  United  States,  and  most  conveniently 
in  towns  which  have  the  means  of  a  ready  and 
cheap  communication  with  the  country.  These 
isocieties  might  solicit  the  public  in  general,  and 
the  personal  acquaintances  of  the  members  in  par- 
ticular, to  furnish  them  with  specimens  of  the  pro- 
ducts of  all  mines,  ore  and  coal-beds,  and  of  mar- 
bles, maris,  clays,  lime-stones,  fossils,  shells  and 
wood,  petrifactions,  crystals,  and,  in  general,  of  all 
minerals  and  fossils  that  appear  worthy  of  atten- 
tion." 

"  It  frequently  happens  in  this  country,  that  far- 
mers discover,  in  ploughing,  and  by  other  means, 
many  objects  well  worthy  of  being  examined  and 


Biographical  Sketch.  Ivii 

preserved,  but  which  are  forgotten  and  lost  for 
want  of  proper  persons  to  examine  them,  and  of  a 
cabinet  to  place  them  in." 

"  2dly.  It  would  greatly  tend  to  illustrate  the 
mineralogy  of  our  country,  and  geology  in  general, 
if,  with  every  sample  received,  there  should  be 
taken  as  exact  an  account  as  may  be  of  the  cir- 
cumstances of  the  place  where  it  was  found,  and 
of  any  facts  explanatory  of  its  natural  history.  A 
paper  containing  a  short  summary  of  such  infor- 
mation might  always  be  annexed  to,  and  accom- 
pany the  specimen." 

"  3dly.  The  societies  formed  might  keep  up  a 
regular  correspondence,  and  might  send,  each  to  all 
the  others,  parts  of  the  specimens  they  receive, 
together  with  the  written  accounts  of  them,  when- 
ever those  specimens  are  of  a  kind,  and  in  suffi- 
cient quantity  to  be  divided.  It  would  also  be  use- 
ful to  analyze  parts  of  the  specimens  received,  and 
to  communicate  the  result.  We  conceive,  also, 
that  it  would  not  be  necessary  to  confine  our  ca- 
binets too  strictly  to  objects  merely  mineral:  what- 
ever tends  to  illustrate  the  history  of  the  earth 
and  of  its  component  parts,  might,  perhaps,  be 
admitted  with  advantage." 

"  A  correspondence  of  this  kind,  if  actively  pu  rsu- 

ed  a  few  years,  would  furnish  our  country  with  se- 

h 


Iviii  Biographical  Sketch. 

veral  valuable  cabinets  of  mineralogy  at  little  or  nt> 
expense.  These  would  be  repositories  where  per- 
sons inclined  to  investigate  such  subjects,  either 
for  amusement  or  profit,  might  resort  for  infor- 
mation. They  would  enable  the  inhabitants  of 
any  one  part  of  the  Union  to  take  a  view  of  the 
mineralogy  of  the  whole  United  States." 

4'  The  Chemical  Society  of  Philadelphia  have 
laudably  set  the  example,  by  solicith.g  iniormation 
upon  the  resources  of  our  country,  for  furnishing 
an  article  of  great  national  importance.  We  also 
solicit  the  correspondence  of  societies  and  of  in- 
dividuals, upon  all  subjects  mentioned  in  this  ad- 
dress, and  in  our  former  advertisement.  In  par- 
licular,  the  society  requests  of  farmers,  miners, 
-travellers,  and  collectors  of  private  cabinets,  any 
specimens  of  minerals  and  fossils  which  it  may  be 
in  their  power  to  furnish,  together  with  any  in- 
telligence respecting  them  ;  and  the  society  will 
not  fail,  on  its  part,  to  furnish  any  information  in 
its  power,  derived  from  assay,  analysis,  or  other- 
wise, and  to  communicate  it,  with  freedom  and 
with  pleasure,  to  societies  and  to  individuals." 

The  malignant  and  fatal  epidemic  of  1798,  is 
but  too  well  recollected,  by  every  adult  inhabi- 
tant of  New-  York.  Doctor  Miller  had  then  been 
residing  two  years  in  the  city ;  and  had  found  his 
medical  practice  considerably  increased.     As  he 


Biographical  Sketch.  Ux 

believed  the  Yellow  Fever  to  be  neither  imported 
nor  contagious,   and  as  his  residence  was  in  the 
most  healthy  street  in  the  city,  he  early  resolved 
to  commit  himself  to  the  care  of  Providence,  and 
to  remain  at  his  post.    He  did  so  ;  and  was  merci- 
fully preserved.     The  writer  of  this   sketch  also 
remained  in  the  city,  during  that  melancholy  sea- 
son, and  spent  the  whole  of  it  under  the  same 
roof  with  his  Brother  ;  and  never  shall  he  forget 
either,   on  the  one  hand,  the  persevering  and  al- 
most incredible  labours  of  that  beloved  Relative  ; 
or,  on  the   other,   the   gloom  and  horror   of  the 
general  scene.      Doctor  Miller  visited  all  who 
sent  for  him,   without  discrimination  or  reserve. 
The  rich,  who  were  able  to  remunerate  him,  had 
chiefly  left  the  city  :  his  professional  labours  were 
in  a  great  measure  devoted  to  the  poor  and  forsa- 
ken, from  whom  no  recompense  could  be  expect- 
ed.    Yet  he  attended  them  with  unceasing  assi- 
duity ;  though  he  often  exhibited  such  marks  of 
fatigue,  exhaustion,  and  mental  depression  on  ac- 
count of  the  scenes  through  which  he  passed,  as 
could  not  have  been   described,   or  easily   con- 
ceived, without  personally  witnessing  them.     It 
pleased  God  to  carry  him  through  the  season  in 
safety  ;  and  it  proved  of  essential  service  to  him, 
not  only  in  contributing  to  the  rapid  and  great  ex- 
tension of  his   medical  practice  ;   but  also  in  en- 
larging the  sphere  of  his  experience,  and  in  ena- 
bling him  afterwards  to  write  with  more  intelli- 


lx  Biographical  Sketch. 

gence,  discrimination,  and  confidence  on  the  sub- 
ject of  that  awful  epidemic. 

Among  the  victims  of  this  wasting  disease,  in 
the  season  of  which  we  are  speaking,  Doctor 
Miller  was  called  to  lament  the  loss  of  his  affec- 
tionate friend,  and  able  colleague,  Doctor  Elihu 
H.  Smithy  who,  in  the  morning  of  life  and  use- 
fulness, and  in  the  midst  of  professional  exertions, 
as  honourable  to  himself,  as  they  were  beneficial 
to  others,  was  sent  to  a  premature  grave.  This 
was,  on  a  variety  of  accounts,  a  very  distressing 
bereavement  to  the  surviving  editors  of  the  Med- 
ical Repository ;  but  the  circumstances  under 
which  it  occurred,  rendered  it  doubly  gloomy  and 
depressing.  Never  can  the  writer  of  these  lines 
forget  the  funeral  of  Doctor  Smith.  It  was  when 
the  ravages  of  pestilence  had  become  so  tremen- 
dous as  to  drive  almost  every  individual  from  the 
city  who  was  able  to  fly  ;  when  scarcely  any  pas- 
sengers were  to  be  seen  in  the  streets,  but  the 
bearers  of  the  dead  to  the  tomb  ;  and  when  it  ap- 
peared as  if  the  reign  of  death  must  become  uni- 
versal ; — it  was  in  circumstances  such  as  these, 
that  Doctors  Mitchill  and  Miller,  accompanied 
with  two  or  three  other  friends,  bedewed  with 
their  tears,  and  followed  to  the  grave,  the  re- 
mains of  a  Young  Man,  in  some  respects  one  of 
the  most  enlightened  and  promising  that  ever 
adorned  the  annals  of  American  science. 


Biographical  Sketch.  lxi 

In  the  year  1801,  the  writer  of  these  memoirs 
undertook  a  work,  which  was  published  soon  af- 
terwards, under  the  title  of  A  Brief  Retrospect  of 
the  Eighteenth  Century  ;  Part  First,  containing  a 
Sketch  of  the  Revolutions  and  Improvements  in 
Science,  Arts,  and  Literature,  during  that  period. 
The  tolerable  completion  of  his  plan  obliged  him  to 
attempt  an  exhibition  of  the  principal  discoveries- 
and  improvements  in  Medicine,  during-  the  period 
which  was  to  be  delineated.  When  he  came  to 
that  part  of  his  work,  his  Brother,  with  that  affec- 
tion for  which  he  was  always  distinguished,  offered 
to  furnish  the  requisite  materials,  and  to  give  any 
other  assistance  in  his  power.  This  offer  was  ac- 
cepted, and  was  more  than  realized.  The  readers 
of  the  "  Retrospect"  have,  doubtless,  observed, 
that  the  chapter  on  "  Medicine"  is  by  far  the  best 
part  of  the  work.  Its  matter,  its  arrangement 
and  its  style,  are  all  superiour  to  those  of  any  other 
in  the  volumes.  The  truth  is,  that  three- fourths 
of  that  chapter  were  written  by  Doctor  Edward 
Miller  ;  a  few  pages  only  of  the  latter  (and  cer- 
tainly the  inferiour )  part  being  written  by  the  au- 
thor of  the  main  body  of  that  publication.  Per- 
mission was  earnestly  and  repeatedly  requested 
from  him  to  state  this  to  the  public  in  a  note,  at 
the  commencement  of  the  chapter  in  question  ; 
but  he  pointedly  and  perseveringly  refused.    His 


-Ixii  Biographical  Sketch. 

native  modesty  shrunk  from  such  an  obtrusion 
of  his  name  on  the  public  notice.  He  had  writ- 
ten in  haste,  and  considered  the  sketch  which  he 
had  furnished,  though  adapted  to  the  place  which 
it  was  intended  to  occupy,  as  by  no  means  suffi- 
ciently digested  to  be  sent  abroad  under  the  name 
of  a  physician.  And,  what  probably  operated 
with  no  less  force,  such  was  his  uniform  and  ten- 
der affection  for  his  Brother,  that  he  was  willing 
to  transfer  to  him,  whatever  credit  in  public  esti- 
mation might  be  attached  to  that  part  of  the  work. 
That  brother,  however,  who  feels  a  confidence 
founded  on  the  opinion  of  much  better  judges 
than  himself,  that  the  chapter  in  question,  the  more 
it  is  examined,  will  be  found  more  distinctly  to 
bear  the  marks  of  the  vigorous,  comprehensive, 
well-stored,  and  polished  mind,  by  which  the 
greater  part  of  it  was  produced,  considers  him- 
self as  now  at  liberty  to  give  the  history  of  its 
composition.  He  takes  more  pleasure  than  he 
can  well  express  in  perusing  that  chapter  as  a 
memorial  of  his  relation  to  one  to  whom  he  feels 
next  to  his  Parents,  more  indebted  than  to  any 
ether  mortal ;  and  whose  numberless  monuments 
of  fraternal  affection,  he  cannot  contemplate  with- 
out the  tenderest  emotions. 

Doctor  Miller  had  not  been  many  years  esta 
Wished  in  the  practice  of  his  profession  in  New- 


Biographical  Sketch.  lxiii 

York,  before  he  received  testimonies  of  public 
confidence  of  the  most  decisive  and  honourable 
kind.  Soon  after  the  commencement  of  that  dis- 
tressing period,  in  which  the  principal  cities  of 
the  United  States,  were  almost  annually  visited 
with  malignant  fever,  the  Legislature  of  the  State 
passed  an  Act  for  preventing  the  introduction  of 
pestilential  diseases.  By  that  act,  the  execution 
of  its  provisions  was  entrusted  to  three  principal 
officers.  One  of  these  was  called  the  Resident 
Physician,  because  it  was  his  duty  to  reside  in 
the  city  of  Arexv-  York  ;  to  watch  and  give  notice 
of  the  progress  of  malignant  epidemics  ;  and 
promptly  to  adopt  such  measures  as  exigencies 
may  require.  To  this  office,  at  all  times  full  of 
hazard  and  responsibility,  and  at  that  time  pecu- 
liarly so,  Doctor  Aliller  was  appointed,  by  the 
Governour  and  Council,  at  Albany,  in  1803,  as 
the  successor  of  Doctor  Tillary.  In  the  several 
pestilential  seasons  which  succeeded  this  appoint- 
ment, he  fulfilled  the  duties  of  his  office  with  skill, 
intrepidity,  and  universal  acceptance.  His  dili- 
gence, his  firmness,  his  discernment,  his  prudence, 
his  mildness  and  urbanity  of  address,  and  his  un- 
wearied perseverance,  were  all  qualifications  which 
fitted  him  pre-eminently  for  a  place,  in  which 
public  safety,  as  well  as  public  feelings  and  pre- 
judices, were  to  be  so  constantly  consulted  and 
managed.  He  continued  to  hold  this  important 
station  until  the  winter  of  the  year  1810,  when 


lxiv  Biographical  Sketch. 

the  political  sentiments  of  the  Council  undergoing 
a  change,  he  was  superseded,  solely  and  avowedly 
on  political  grounds.  In  the  course  of  the  year 
following,  when  the  Council  reverted  to  their  for- 
mer sentiments,  he  was  restored  to  the  office,  and 
continued  to  hold  it  until  his  death.  He  was 
succeeded  by  Doctor  M'Neven. 

The  summer  and  autumn  of  1805  was  the  last 
season  in  which  Doctor  Miller  was  called  to  wit- 
ness the  distressing  and  fatal  ravages  of  yellow  fe- 
ver. At  the  close  of  the  season,  in  his  official 
character  as  Resident  Physician,  he  addressed  to 
his  excellency  governour  Lewis,  a  Report  of  the 
rise,  progress,  and  termination  of  that  disease. 
To  this  detail,  he  added  an  exhibition  and  defence 
of  the  doctrine  concerning  the  origin  of  yellow 
fever,  which,  after  much  inquiry,  and  long  expe- 
rience, he  had  adopted.  This  Report  was,  short- 
ly afterwards,  laid  before  the  public ;  and  has 
been  pronounced,  by  good  judges,  to  be  one  of 
the  most  luminous,  forcible,  comprehensive,  and 
satisfactory  defences  of  the  doctrine  which  it  sup- 
ports, that  ever  appeared,  within  the  same  com- 
pass, in  any  language.  The  substance  of  this 
Report,  with  additions,  was  afterwards  subjoined, 
by  the  author,  as  an  appendix  to  the  American 
edition  of  Dr.  Thomas' 's  "  Modern  Practice  of 
Physic." 


Biographical  Sketch.  Ixv 

But  in  1807,  a  new  and  still  more  interesting- 
field  of  employment  was  opened  to  him.     As  long 
ago  as  the  year  1791,  it  had  appeared  to  many 
members  of  the  medical   profession,  that  they 
might  derive  important  advantages  from  being 
incorporated  as  a  College  of  Physicians.     By  one 
of  the  early  laws  of  the  State  of  New-  York,  the 
power  of  incorporating  colleges  as  well  as  acade- 
mies, had  been  granted  to  the  "  Regents  of  the 
University  of  New-  York. "      Doubts,  however, 
having  been  entertained  whether  the  authority  so 
vested,  extended  to  the  creation  of  a  Medical  In- 
stitution, the  Legislature  enacted  an  express  sta- 
tute, empowering  the  Regents  to  incorporate  a 
"  College  of  Physicians  and  Surgeons."      But 
difficulties  of  various   kinds  arose,  and  the  plan 
was  never  carried  into  execution  until  the  month 
of  March,  1807.     Then,  at  the  warm  and  pressing 
instance  of  Doctor  Nicholas  Romayne,  seconded 
by  other  friends  of  the  Institution,  and  during  the 
administration  of  Governour  Leivis,  a  Charter  was 
obtained  for  associating  the  physicians  into  a  Col- 
lege.    One  great  object  in  constituting  this  incor- 
poration was  the  promotion  of  professional  educa- 
tion upon  a  regular  and  enlarged  plan.     Such  a 
plan  was  immediately  carried  into  effect.     In  a 
few  weeks  after  the  charter  was  granted,  profes- 
sorships  were   formed,   and   professors   elected. 
The  chair  of  the  Practice  of  Physic  was  given  to 


lxvi  biographical  Sketch. 

Doctor  Miller ;  and  he  entered  on  the  duties  of 
his  office  in  the  month  of  November  following. 

He  by  no  means  regarded  this  professorship  as 
a  mere  title  of  honour.  Strict  fidelity  to  every 
trust  reposed  in  him  was  one  of  the  first  articles 
in  his  moral  and  professional  creed.  He  there- 
fore began  immediately  to  prepare  himself  for  that 
course  of  public  instruction  which  his  office  de- 
manded ;  and  it  proved  such  as  his  talents,  his 
learning,  and  his  zeal  had  taught  his  friends  to 
expect.  "  His  Lectures,"  says  one,  who  is  a 
competent  judge,  "  were  highly  commended  by 
"  his  hearers,  as  combining  much  instructive 
"  matter,  with  an  unusually  agreeable  manner." 
And  another,  no  less  competent,  pronounced  them 
to  have  been  ' '  probably  among  the  best  specimens 
"  of  public  medical  instruction  ever  exhibited  in 
"  our  country." 

Doctor  Miller  generally,  and  more  especially 
on  some  occasions,  appeared  so  advantageously  in 
the  Professor's  chair,  that  many  of  his  hearers 
took  for  granted  that  the  most  of  his  Lectures 
were  completely  and  carefully  written.  And,  ac- 
cordingly, the  "writer  of  these  memoirs,  from  re- 
presentations of  this  kind  having  been  so  frequent- 
ly made  to  him,  confidently  expected  to  find 
among  his  Brother's  papers  a  number  of  manu- 
script Lectures  of  this  description.     In  this  ex- 


Biographical  Sketch.  lxvii 

pectation,  however,  he  was  disappointed.  He 
found  only  three,  in  any  thing  like  a  state  of  com- 
pleteness, and  these  were  all  Introductory  Lec- 
tures.* Of  the  rest,  he  discovered  only  short 
(and  sometimes  very  short)  notes,  or  hints,  which 
had  been  extemporaneously  amplified  into  those 
connected,  luminous,  and  instructive  discourses, 
which  gave  so  much  satisfaction,  and  which  his 
hearers  generally  believed  to  have  been  laboriously 
prepared. 

In  the  year  1809,  Doctor  Miller  was  appointed 
one  of  the  physicians  of  the  New-  York  Hospital ; 
and,  soon  afterwards,  received  the  appointment  of 
Clinical  Lecturer  in  that  Institution.  To  the  va- 
rious duties  of  these  new  stations,  he  addressed 
himself  with  all  that  diligence  and  assiduity,  which 
his  zeal  for  the  promotion  of  medical  knowledge, 
and  his  desire  to  serve  the  interests  of  humanity, 
could  dictate.  The  second  of  the  Introductory 
Lectures  which  make  a  part  of  this  volume,  was 
delivered  at  the  commencement  of  one  of  his 
courses  of  Clinical  Lectures  in  the  Hospital ;  and 
it  may  be  said  of  the  whole,  that  they  were  not 
less  instructive  and  useful,  than  those  which  he 
delivered  as  Professor.  "  His  junior  contempo- 
"  raries,"  said  one  of  his  learned  medical  Friends, 
"  will  long  remember  the  sympathy  for  the  sick, 
"  and  the  regard  for  the  well,  which  characterized- 

*  These  are  all  published  at  the  close  of  the  present  volume 


lxviii  Biographical  Sketch. 

"  his  bed-side  instructions.  They  will  never  for- 
"  get  the  sound  judgment  which  guided  his  prac- 
"  tice,nor  the  winning  urbanity  which  distinguish- 
"  ed  his  discourses." 

While  Doctor  Miller  was  assiduously  and  ably 
fulfilling  the  duties  of  the  various  public  stations 
which  have  been  mentioned,  and  attending  to  the 
multiplied  calls  of  a  large  practice,  he  was  engaged 
in  an  extensive  correspondence  with  eminent  phy- 
sicians and  others,  in  almost  every  part  of  Eu- 
rope and  America.*  Though  in  literature  and 
science,  as  well  as  in  politics,  he  was  a  thorough- 
going American  ;  and  was  very  far  from  joining 
with  those  who  either  deny  the  capacity,  or  des- 
pise the  attainments,  of  American  genius.  Nay, 
though  he  thought  that  his  own  country,  for  her 
inquiries  and  improvements,  was  entitled  to  a  full 
share  of  credit  from  the  medical  world ;  yet  he 
had  a  liberality  and  magnanimity  of  spirit,  which 
prompted  him  to  look  with  eagerness  to  every 
part  of  the  globe  from  which  new  light  might  be 
expected,  and  to  hail  its  appearance  whencesoever 

*  Among  his  numerous  foreign  correspondents  at  different 
periods,  the  following  are  recollected  by  the  editor.  Doctor 
Duncan,  of  Edinburgh  ;  Doctor  Beddoes  of  Bristol  ;  Doctor 
Currie,  of  Liverpool;  Doctors  Mosely,  Heberden,  Pearson, 
and  Lettsom,  of  Londoii ;  Doctor  Patterson,  of  Londonderry  ■ 
Corvisart,  of  Paris  ;  Doctor  Valentin,  of  Montpcllier  ;  Doctor 
Olbers,  of  Bremen  ;  Professor  Ebeling,  of  Hamburgh  ;  and 
Doctor  Bancroft  of  Jamaica. 


Biographical  Sketch.  lxix 

it  might  come.  He  contemplated  with  profound 
respect  the  venerable  institutions  of  Europe  ;  and 
took  peculiar  pleasure  in  maintaining  such  a  fo- 
reign as  well  as  domestic  correspondence,  as  made 
him  early  acquainted  with  all  important  discoveries 
and  improvements  in  every  part  of  the  scientific 
world. 

The  testimonies  of  respect  which  Doctor  Miller 
received  from  various  parts  of  his  own  country, 
were  numerous  and  flattering.  In  the  year  1805, 
he  was  elected  a  member  of  the  "  Philosophical 
Society,  held  at  Philadelphia,  for  promoting 
Useful  Knowledge."  The  principal  medical  so- 
cieties, in  almost  all  the  States  in  the  Union,  did 
him  the  honour  to  enrol  his  name  among  their 
Corresponding  or  Honorary  members.  And  the 
letters,  which,  every  week,  flowed  in  upon  him, 
from  all  quarters,  communicating  medical  intelli- 
gence, or  soliciting  professional  advice,  furnished 
the  most  decisive  evidence  of  the  large  share  of 
public  confidence  which  he  enjoyed,  and  of  his 
growing  reputation. 

Thus  occupied  in  public  and  private  business, 
accumulated  to  such  an  amount  as  scarcely  to 
leave  him  an  hour  of  repose,  either  by  day  or  by 
night,  he  was  arrested  by  that  iron  grasp  of  Dis- 
ease, from  which  he  had  so  often  been  the  means 
of  disengaging  others,  and,  to  the  grief  of  all  who 


Ixx  Biographical  Sketch. 

knew  him,  sunk  under  its  power.  So  full  an  ac- 
count of  the  progress  and  termination  of  this  dis- 
ease, will  be  given  presently,  in  the  language  of 
one  of  his  medical  Friends,  that  it  is  unnecessary 
to  dwell  on  the  subject  here.  Suffice  it  to  say, 
that  after  the  most  flattering  hopes  of  recovery  had 
been  for  some  days  cherished  by  all  around  him, 
and  when,  indeed,  every  idea  of  danger  had  been 
dismissed,  he  suddenly  relapsed,  on  the  14th,  and 
died  on  the  17th  of  March,  1812,  in  the  fifty- 
second  year  of  his  age. 

The  writer  of  this  tribute  of  fraternal  affection, 
instead  of  attempting,  if  it  were  possible,  to  ob- 
trude on  public  view  the  emotions  which  filled  his 
own  bosom,  when  an  only  Brother,  and  such  a 
Brother,  was  so  unexpectedly  torn  from  life  and 
usefulness,  will  take  the  liberty  of  introducing  the 
language,  and  exhibiting  the  feelings  of  more  im- 
partial judges.  Out  of  many  letters  of  condo- 
lence, or  testimonies  of  respect  which  came  to  his 
hands,  a  few  only  can  be  selected. 

On  the  third  day  after  the  death  of  Doctor  Mil- 
ler, the  following  Letter  was  received  from  that 
venerable  Man,  and  first  of  American  Physicians, 
who  had  been  the  paternal  Friend  of  his  youth, 
and  had  followed  him,  with  the  tenderest  affection, 
to  the  end  of  life  ;  and  who,  alas  !  to  the  regret  of 
every  friend  of  humanity,  science  and  genius,  was 


Biographical  Sketch.  Ixxi 

destined  to  survive  him  but  little  more  than  a 
year. 

11  Philadelphia,  March  19th,  1812.r 

U  My  dear  Friend," 

"  Col.  MlLane  communicatee}  to  me  in  a  short 
note,  yesterday  morning,  the  distressing  intelli- 
gence of  the  death  of  my  much- loved  and  invalu- 
able Friend.  It  afflicted  me  in  the  most  sensible 
manner.  He  was  very  dear  to  me,  not  only  from 
his  uncommon  worth ;  but  also  because  he  was 
my  early  and  uniform  friend.  In  an  intercourse 
of  thirty  years,  I  never  saw  any  thing  in  him  that 
was  not  calculated  to  excite  affection,  esteem,  and 
admiration.  During  the  confederacy  of  my  bre- 
thren against  me,  in  the  memorable  years  in  which 
the  Yellow  Fever  prevailed  in  our  city,  he  openly 
advocated  my  principles  and  practice  ;  and  by  the 
weight  of  his  name,  and  the  learning  and  ingenuity 
of  his  publications,  contributed  very  much  to  their 
establishment  in  our  country.  Judge  of  my  af- 
fection for  him,  and  the  value  I  placed  upon  his 
integrity  and  friendship,  when  I  add,  that,  four  or 
five  years  ago,  in  a  private  interview,  in  my  own 
house,  I  committed  my  lectures  and  manuscripts 
to  him,  to  be  revised  by  him,  and  published  or 
destroyed  as  he  saw  proper,  after  my  death.  He 
received  this  communication  with  a  good  deal  of 


Ixxii  Biographical  Sketch. 

emotion,  and  promised  to  fulfil  my  wishes,  in  case 

he  should  survive  me. But  why  do  I  complain 

of  the  loss  I  have  sustained  by  his  death  ?  Science, 
Literature,  Humanity,  the  United  States,  have  all 
been  deprived  of  one  of  their  strongest  pillars, 
and  most  beautiful  ornaments.  They  will  long, 
very  long  deplore  his  early  and  premature  removal 
from  the  high  and  useful  station  he  filled  in  life. 
They  now  mingle  their  tears  with  yours  and  mine. 
When  the  late  Reverend  William  Tennent,  of 
Freehold,  heard  of  the  death  of  his  friend,  Doctor 
Finley*  he  cried  out,  "  I  feel  as  if  I  had  lost  my 
"  broad- side.  He  was  my  brother.  I  could  have 
"  gone  to  prison  and  to  death  with  him  !"  I 
imagine  we  both  feel  disposed  to  adopt  the  same 
affectionate  and  passionate  expressions  in  revolv- 
ing in  our  minds  the  uncommon  virtues  and  at- 
tainments of  our  departed  Friend  and  Brother. 
His  death  has  rendered  the  republic  of  medicine 
a  solitude  to  me  ;  for  he  filled  a  place  in  my  bo- 
som which  no  physician  in  our  country  is  able,  or, 
if  able,  not  willing  to  occupy." 

"  But  in  thus  venting  our  sorrows  to  each  other, 
let  us  not  forget  the  dictates  of  the  holy  religion 
we  profess.  God  never  created  any  creature  com- 
fort, not  even  the  innocent  delights  of  friendship 
and  fraternal  affection,  to  rise  in  rebellion  against 

*  The  Reverend  Doctor  Finley,  President  of  the  College 
of  New-Jersey.     Edit. 


Biographical  Sketch.  lxxiii 

himself;  arid  however  severely  we  may  feel  the 
loss  of  them,  it  is  probably  intended  to  teach  us 
that  they  are  not  indispensably  necessary  to  our 
substantial  and  permanent  happiness  ;  and  that 
there  is  indeed  "  a  Friend  that  sticketh  closer 
than  a  brother." 

"  I  will  endeavour  to  write  something  for  the 
public  eye  on  this  distressing  occasion.  But  ah  ! 
my  friend, 

"  Grief  unaffected  suits  but  ill  with  art* 

"  And  flowing  periods  with  a  bleeding  heart."  : 

"  Since  the  death  of  my  illustrious  fellow-la- 
bourer in  the  science  of  Medicine,  and  the  awful 
summons  it  has  conveyed  to  me  from  the  grave, 
I  feel  my  ardour  in  my  professional  pursuits  sud- 
denly suspended,  and  am  ready  to  say  to  the 
sources  of  all  my  knowledge  and  pleasures,  in  the 
language  of  the  Scotch  poet,  a  little  varied." 

*  "  Books,  wander  where  ye  like,  I  dun  no  care, 
"  I'll  break  my  pen,  and  never  study  mare."  ' 

"  Accept  of  my  tenderest  sympathy  for  the 
death   of  your   darling   little   boy.*     Ah !    Dr. 

*  This  paragraph  refers  to  another  bereavement  which  the 
writer  of  the  present  sketch  was  called  to  sustain,  a  little  more 

k 


lxxiv  Biographical  Sketch. 

Miller,   Dr.   Miller!   my  son,   my   friend,    my 
brother !" 

"  Benjamin  Rush." 
"  Reverend  Doctor  Miller.''' 

In  a  day  or  two  after  the  date  of  the  preceding 
letter,  a  "  tribute  of  respect"  from  the  same  pen, 
appeared  in  one  of  the  gazettes  of  Philadelphia,  of 
which  the  following  is  an  extract. 

"  But  Dr.  Miller  was  not  a  citizen  of 


New-  York  only.  He  lived  throughout  the  whole 
republic  of  medicine  in  every  part  of  the  world  by 
means  of  an  extensive  correspondence,  for  which 
he  was  admirably  fitted,  not  only  by  his  uncommon 
fund  of  knowledge,  but  by  a  facility  and  elegance 
in  letter- writing  which  have  rarely  been  equalled, 
and  perhaps  never  surpassed.  In  this  way  he  be- 
came a  channel  through  which  every  thing  new  in 
medicine  in  foreign  countries  was  immediately 
communicated  to  his  own."     . 

"  His  fellow-citizens  in  New-York  were  not 
insensible  of  his  worth.  In  the  year  1805,  he  was 
appointed  Resident  Physician  of  the  port  of  New- 
York,  and  in  the  year  1809,  Professor  of  the  Prac- 


than  a  mouth  before  the  death  of  his  Brother ;  on  which  oc- 
casion the  sympathy  and  tenderness  of  that  Brother,  »<  ihvy 
cannot  be  described,  so  they  will  never  be  forgotten. 


Biographical  Sketch.  lxxv 

tice  of  Medicine,  in  the  New  College  of  Physi- 
cians. From  the  elevated  station  in  which  his  ta- 
lents and  virtues  had  thus  placed  him,  and  in  the 
meridian  of  his  usefulness,  with  every  enjoyment 
that  affluent  business,  a  well-earned  reputation, 
numerous  friends,  and  an  affectionate  brother  and 
sister  could  confer,  it  pleased  God  to  remove  him 
from  our  world." 

"  It  is  to  commend  him  partially  to  say,  he  was 
a  learned  and  skilful  physician,  and  a  man  of  gene- 
ral science.  He  was  at  the  same  time  a  radical  and 
accurate  English,  French  and  Latin  Scholar,  and 
his  mind  was  stored  with  the  beauties  of  the  most 
celebrated  poets  and  historians  of  Britain,  France 
and  Rome.  But  his  principal  merit  was  of  a  mo- 
ral nature. — The  charm  that  was  constantly  dif- 
fused over  his  countenance  and  manners,  was  the 
effect  of  the  habitual  benevolence  of  his  temper. 
The  silence  of  pain  and  the  eye  of  hope,  which 
took  place  in  his  patients  the  moment  he  sat  down 
by  their  bed-sides,  were  produced,  not  more  by 
their  conviction  of  his  skill,  than  by  their  unlimit- 
ed confidence  in  his  sympathy  and  integrity  ;  and 
the  affectionate  attachment  and  esteem  of  his 
friends  was  founded  in  a  belief  that  his  deeds  of 
kindness  to  them,  were  not  simply  the  effects  of 
spontaneous  feeling,  but  the  result  of  a  heartfelt 
sense  of  moral  obligation, " 


lxxvi  Biographical  Sketch. 

"  Let  the  Professors  and  Students  of  the  heal- 
ing art,  and  the  lovers  of  Science,  every  where  de- 
plore the  death  of  this  eminent  physician,  and  ex- 
cellent man.  Let  the  friends  of  humanity  drop  a 
tear  over  his  untimely  grave.  In  the  records  of 
illustrious  men  who  have  promoted  and  adorned 
the  science  of  our  country,  Dr.  Miller  will  al- 
ways maintain  a  distinguished  rank.  Alas  !  this 
ornament  of  both,  is  now  no  more  !" 

Doctor  Valentine  Seaman,  of  New-York,  be- 
tween whom  and  Doctor  Miller,  there  had  existed, 
for  a  number  of  years,  a  personal  friendship  and  a 
professional  intercourse  of  the  most  intimate  and 
confidential  kind,  was  one  of  the  most  sincere 
mourners  at  his  death.  At  the  commencement  of 
his  next  course  of  Clinical  Lectures  in  the  New- 
York  Hospital,  this  highly  respectable  Physician 
and  medical  Instructor,  thought  proper  to  pay  a 
tribute  of  respect  to  the  memory  of  his  Friend, 
which  the  editor  was  persuaded  he  should  gratify 
his  readers  by  soliciting  for  insertion  in  this  place.* 
Doctor  Seaman  thus  addressed  his  pupils. 

*  In  this  extract  from  Doctor  Seamatfs  Lecture  the  reader 
will  perceive  several  sentences  which  contain  a  repetition,  in 
a  degree,  of  some  facts  before  stated.  As  it  was  not  easy, 
however,  to  detach  these  sentences  from  the  parts  with  which 
they  are  connected,  without  injury  to  the  whole,  it  was  judged 
expedient  to  retain  them. 


Biographical  Sketch.  lxxvii 

"  The  painful  task  still  remains.  It  re- 
mains for  me  to  announce  to  you  the  death  of  our 
much  esteemed,  and  ever  to  be  lamented  friend 
and  colleague,  the  late  Dr.  Edward  Miller.  Those 
among  you  who  have  ever  experienced  the  loss 
of  a  near  and  dear  friend  ;  who  have  felt  the  ten- 
der emotions  which  make  the  mind  delight  to 
dwell  upon  the  recollections  of  their  virtues,  and 
to  recount  their  amiable  qualities,  I  am  sure  will 
excuse  me  in  detaining  you  a  few  minutes,  while 
I  attempt  a  short  account  of  the  character,  and  of 
the  death  of  this  most  excellent  man." 

"  Upwards  of  twelve  years  of  uninterrupted 
friendship,  of  close  and  continued  professional  in- 
tercourse, of  repeated  reciprocations  of  profes- 
sional favours,  and  of  unbroken  confidence,  have 
caused  his  death  to  inflict  a  wound  in  my  feelings, 
which  time  itself  will  never  heal ;  to  produce  a 
chasm  in  the  mind  which  never  will  be  filled  up. 
'Tis  not,  however,  from  these  mere  personal  con- 
siderations, that  I  should  presume  upon  your  pa- 
tience ;  but  there  was  something  so  exemplary  in 
the  life  of  Dr.  Miller  ;  something  so  richly  re- 
warded too,  by  the  esteem  and  affection  of  an  ex- 
tensive acquaintance,  and  by  the  general  respect 
of  the  medical  profession,  and  of  the  community 
at  large,  that  humanity  itself  would  seem  to  forbid 
our  not  holding  it  up  to  the  admiration  of  his  sur- 
vivors as  an  incentive  to  a  generous  emulation." 


lxxviii  Biographical  Sketch, 

"  Dr.  Miller  had  been  complaining  of  some  pain 
in  his  chest  and  feverishness,  for  several  days  pre- 
vious to  his  being  confined  to  the  house.  At  a 
sickly  season,  with  a  number  of  patients  under  his 
care,  from  whom  he  hardly  knew  how  to  withhold 
his  services,  he  continued  to  visit  them  much 
longer  than  an  attention  to  his  own  welfare  would 
justify.  On  the  22d  of  February,  not  being  any 
longer  able  to  go  out,  he  reluctantly  consented  to 
keep  house  ;  and  for  the  greater  part  of  the  time 
kept  his  bed  ;  still,  however,  admitting  messages 
from  his  patients,  and  wearying  himself  in  giving 
advice.  These  services,  also,  after  a  few  days, 
he  was  obliged  to  relinquish." 

"  After  more  than  two  weeks  of  distressing  and 
severe  illness,  with  almost  unceasing  watchfulness, 
his  complaints  gradually  abated ;  his  sleep  return- 
ed ;  the  pain  in  his  chest  subsided  ;  his  cough  had 
become  trifling  ;  and  his  fever  nearly,  if  not  quite, 
gone.  He  was  still,  however,  very  weak ;  yet 
not  so  much  so  but  that  he  could  sit  up  for  several 
hours  together. — Just  at  this  time,  giving  way  to 
the  strong  bent  of  his  mind,  he  indulged  himself 
in  the  perusal  of  letters  and  pamphlets  which  had 
been  accumulating  upon  his  table  during  the  more 
severe  state  of  his  disease.  He  passed  nearly  five 
hours  in  looking  them  over.  This  indulgence, 
alas  !  was  a  fatal  one  !  The  mind  over- stretched, 
and  the  debilitated  body  overpowered,  by  the  too 


Biographical  Sketch*  lxxix 

great  exertion,  a  restless  night  succeeded,  with  a 
return  of  fever  and  some  slight  marks  of  delirium ; 
all  of  which  rapidly  increasing,  in  fifty- six  hours 
terminated  his  life.  At  8  o'clock  in  the  morning, 
on  the  17th  day  of  March,  amidst  the  lamentations 
of  his  friends,  he  breathed  his  last." 

"  This  mournful  event  was  no  sooner  known 
to  the  anxious  crowd  surrounding  his  door,  than 
it  was  spread  in  every  direction.  In  a  very  little 
time  it  was  known  throughout  the  city  ;  and 
many  of  its  most  worthy  and  respectable  inhabi- 
tants felt  the  shock  as  from  the  loss  of  one  of  their 
own  family ;  for  such  was  the  affectionate  deport- 
ment of  Dr.  Miller  towards  those  under  his  care, 
that  many  seemed  to  claim  him  as  one  of  their 
own  household.  Yet  even  these  were  not  aware 
of  the  degree  of  their  attachment  to  him,  till  his 
death  awakened  them  to  a  more  full  sense  of  their 
loss.  They  mourned;  but  they  mourned  not 
without  cause.  In  Dr.  Miller  they  had  lost 
much.  They  had  lost  an  interesting  friend,  an 
ever- ready  adviser,  their  body-guard  in  health ; 
their  champion,  their  hope  and  confidence  in  dis- 
ease. His  medical  friends  had  still  more  cause 
for  regret.  His  rare  talents,  his  well-stored  mind., 
(always  keeping  pace  with  improvement  in  med- 
ical science)  his  accessibility,  his  freedom  in  com- 
municating every  useful  intelligence,  all  conspired 
to  make  his  loss  be  severely  felt  by  them,  and  es- 


Ixxx  Uiographical  Sketch. 

pecially  by  his  more  immediate  associates  and 
colleagues." 

"  The  general  estimation  in  which  he  was  held 
was  particularly  evinced  at  his  funeral.  In  no  in- 
stance do  we  recollect  to  have  witnessed  so  great 
a  procession  following  the  remains  of  a  private  in- 
dividual to  the  grave.  Nor  was  this  the  effect  of 
extensive  family  connections ;  a  single  relative 
only,  helped  to  lengthen  out  the  solemn  train.  It 
was  the  effect  of  the  regard  that  his  own  personal 
merits  had  commanded.  He  stood  high  in  the 
estimation  of  the  public,  in  the  consideration  of 
his  acquaintance,  and  in  the  hearts  of  his  friends. 
All  seemed  desirous  of  shewing  this  last  mark  of 
respect  to  his  remains.  The  Corporation  of  the 
city,  in  a  body,  with  their  officers;  the  Governours 
of  the  New-  York  Hospital,  with  those  attached  to 
the  establishment  ;  the  members  of  the  Medical 
Society,  and  the  classes  of  the  Students  of  Medi- 
cine, by  previous  resolutions,  all  attended;  which, 
together  with  a  large  concourse  of  other  citizens, 
formed  as  numerous  an  assemblage  of  real  mourn- 
ers, as  perhaps  ever  collected  upon  a  like  occasion." 

"  While  pulpits  and  the  forum  resound  in  eu- 
logizing the  memory  of  the  valiant  and  the  brave; 
in  celebrating  the  achievements  and  the  slaughter- 
ings of  the  war-worn  veteran,  covered  with  the 
blood  of  his  fellow  men  ;  it  hardly  could  be  sup- 


Biographical  Sketch.  lxxxi 

posed  that  the  votaries  of  science  would  permit 
one  of  her  most  favourite  sons  to  sink  in  silence  to 
the  tomb.  No  !  one  whose  time  was  daily  occu- 
pied from  early  dawn,  till  past  the  midnight  hour, 
not  in  contriving  the  destruction,  but,  in  working 
the  preservation  of  mens'  lives,  was  not  to  be  suf- 
fered to  pass  thus  lightly  away.  Scientific  con- 
siderations, personal  feelings,  and  the  general 
good,  all  demanded  some  public  expression  of 
respect ;  some  account  of  the  life  and  of  the  works 
of  so  distinguished  a  character.  Hence,  at  the 
earliest  period  after  his  death,  before  his  remains 
had  yet  pressed  upon  their  bier,  the  members  of  the 
Medical  Institution  resolved  to  commemorate  the 
virtues,  and  to  express  their  sense  of  the  loss,  of 
their  worthy  Associate,  by  a  public  Discourse  up- 
on the  mournful  occasion.  And  Dr.  Watts  soon 
after  delivered,  to  a  large  and  mixed  audience,  an 
appropriate  oration  in  honour  of  his  memory." 

"  Soon  after  his  death,  a  Tribute  to  his  memory, 
from  the  inimitable  pen  of  his  early  and  intimate 
friend  Dr.  liush,  appeared  in  the  public  prints. 
This  publication,  although  without  a  signature, 
yet  from  its  style,  its  lively  expression  of  sympa- 
thetic affection  and  regard,  at  once  betrayed  the 
source  from  whence  it  was  derived.  No  man  knew 
Dr.  Miller  better  than  Dr.  Rush.  No  one  was  more 
capable  of  appreciating  his  merits.  Few  loved 
him  more,  or  more  regretted  his  loss." 

1 


lxxxii  Biographical  Sketch. 

"  Bat  we  rest  not  Dr.  Miller 's  claims  to  respect 
upon  the  grounds  of  funereal  honours.  We  must 
look  at  him  through  his  works.  We  pass  over 
the  little  anecdotes  of  his  early  years  ;  nor,  indeed, 
do  we  know  that  they  ever  evinced  any  decisive 
murks  of  extraordinary  genius.  We  have,  how- 
ever, the  fullest  evidence  of  his  possessing  by  na- 
ture, a  sound  and  a  capacious  mind,  which  by  the 
superintending  care  of  a  faithful  Parent,  well  qua- 
lified for  the  purpose,  was  early  inured  to  assidu- 
ous and  persevering  application  ;  whence  he  was 
enabled  readily  to  overcome  all  the  difficulties  of 
completing  a  knowledge  of  the  dead  languages. 
He  was  master  of  the  Latin  and  Greek,  and  he 
was  no  stranger  to  the  different  dialects  of  modern 
Europe." 

"  After  completing  his  academic  studies,  in 
which  he  had  gained  no  small  share  of  reputation 
for  his  accuracy  in  classical  learning,  he  directed 
his  attention  to  the  study  of  the  healing  art.  How 
fortunate  for  medicine  to  have  a  mind  thus  stored, 
a  mind  in  which  habit  had  made  close  application 
a  seeming  constituent  part  of  its  own  nature ;  a 
mind  accustomed  to  meet  obstructions  without 
dismay,  and  to  overcome  them  without  difficulty, 
enlisted  among  its  votaries  !  Dr.  Miller's  indus- 
trious habits  did  not  forsake  him  in  his  new  pur- 
suit. He  followed  up  his  studies  with  an  ardour 
becoming  their  great  object,  and  succeeded  in  a 


Biographical  Sketch.  lxxxiii 

manner  becoming  the  high  character  he  afterwards 
sustained  in  its  practice." 

"  So  convinced  was  he  of  the  necessity  of  fa- 
miliarizing himself  with  the  appearances  of  dis- 
eases as  they  present  themselves  in  practice,  that, 
after  the  completion  of  his  pupilage,  with  practical 
advantages  equal  to  other  students,  he,  in  1781, 
entered  as  surgeon's  mate  in  the  military  Hospitals 
of  the  United  States,  thus  more  completely  to 
prepare  himself  for  the  important  duties  of  his 
profession.  Although  then  but  a  mere  youth,  his 
profound  medical  erudition,  as  we  are  lately  told 
by  one  of  the  surgeons,  immediately  attracted  the 
attention  and  admiration  of  the  medical  gentlemen 
attached  to  that  department.  The  early  impres- 
sion thus  received,  in  favour  of  Hospital  instruc- 
tion, in  qualifying  for  the  practice  of  medicine, 
continued  with  him,  and  increased  with  his  in- 
creasing years  and  experience.  Hence,  in  a  late 
communication  to  the  governours  of  this  House 
upon  that  subject,  he  remarked,  that  "  It  was 
"  scarcely  necessary  to  observe  that  a  practical 
"  acquaintance  with  medicine  and  surgery,  forms 
"  the  most  important  part  of  the  qualifications  of  a 
"  physician  and  surgeon  :  and  that  this  can  be 
"  best  acquired  by  attending  to  the  appearances 
"  and  treatment  of  diseases  as  exhibited  in  the 
"  practice  of  a  large  hospital."  But  Dr.  Miller 
was  not  to  be  satisfied  with  merely  recommending 


lxxxiv  Biographical  Sketch. 

measures.  He  himself  entered  the  field  ;  he  took 
hold  of  the  plough,  and  looked  not  back.  From 
the  earliest  period  of  his  accepting  the  charge  of  a 
public  teacher,  his  attention  was  particularly  di- 
rected to  clinical  instruction,  and  latterly  he  de- 
clined every  other  concern  in  that  way,  that  he 
might  devote  his  time  more  especially  to  this  ob- 
ject :  for  this  he  gave  up  the  advantages  that 
might  be  more  easily  obtained  in  the  professional 
chair  of  the  Practice  of  Physic.  His  views,  it 
would  hence  appear,  were  not  directed  toward  the 
attainment  of  medical  celebrity.  Of  that  he  had 
full  share  ;  but  had  he  not,  he  certainly  never 
would  have  thought  of  looking  for  it  from  the  ex- 
posed place  of  a  clinical  teacher.  He  well  knew 
that  while  other  professors  might  sit  in  their  chairs 
and  paint  out  diseases,  mark  their  diagnosis,  prog- 
nosticate their  event,  and  prescribe  for  their  cure 
with  the  greatest  ease,  and  in  the  correctest  man- 
ner, the  clinical  teacher  in  an  Hospital  must  meet 
diseases  as  they  come,  complicated  in  endless  va- 
riety :  in  constitutions  whose  habits  he  is  alto- 
gether unacquainted  with ;  in  systems  broken 
down  and  deranged  in  various  and  unknown  ways; 
with  symptoms,  sometimes  in  description  greatly 
exaggerated,  at  others  carelessly  described,  and 
some  again  altogether  unmentioned  by  the  pa- 
tient. No  near  friend  or  intelligent  acquaintance 
to  help  out  the  lame  relation  of  the  disordered  suf- 
ferer ;  no  one  to  say  how  he  was  seized  ;  how  his 


Biographical  Sketch.  lxxxv 

disease  progressed ;  or  what  had  been  attempted 
for  its  relief.  Under  all  these  perplexities  he  has 
to  identify  the  malady,  to  prescribe  for  its  cure, 
and  to  foretel  its  event.  Is  it  possible,  thus  cir- 
cumstanced, but  that  he  will  sometimes  err  in  his 
calculations,  be  deceived  in  his  prognosis,  or  dis- 
appointed in  his  remedies  ?  either  of  which  will 
more  or  less  affect  his  reputation.  No  one,  there- 
fore, aiming  at  eminence,  would  ever  expose 
himself  in  this  department  of  medicine.  But  Dr. 
Miller'1  s  views  were  directed  to  the  advancement 
of  his  profession,  not  of  his  own  fame.  The  good 
works  in  which  he  delighted  I  trust  now  meet 
their  reward  !  His  last  days  were  occupied  in  at- 
tending the  sick,  and  expounding  the  nature  of 
their  diseases,  and  the  grounds  of  his  practice  to 
the  students  of  this  hospital.  Many  now  present 
can  witness  his  disinterested  zeal  and  solicitude 
for  their  improvement,  and  his  continued  and  suc- 
cessful exertions  here  for  the  promotion  of  the 
medical  art.  While  the  lovers  of  science  bemoan 
his  untimely  death,  thus  cut  off  in  the  meridian  of 
his  usefulness  ;  while  they  drop  the  tributary  tear 
to  departed  worth,  let  his  surviving  colleagues,  by 
a  redoubled  diligence,  endeavour  to  lessen  the  ef- 
fects of  your  loss." 

"  The  literary  character  of  Dr.  Miller  is  well 
exhibited  in  his  writings,  contained  principally  in 
the  pages  of  the  Medical  Repository,  in  the  con- 


lxxxvi  Biographical  Sketch. 

ducting  of  which,  from  its  first  establishment  to 
nearly  the  completion  of  the  last  volume,  he  per- 
formed the  part  of  an  active  editor.  It  is  to  his 
attentive  observations  and  accurate  investigations 
detailed  in  that  work,  together  with  some  distinct 
papers  upon  the  subject,  particularly  his  Report 
to  governour  JLewis,  that  we  are  much  indebted 
for  the  opinions  now  more  generally  entertained 
in  regard  to  the  nature  of  the  yellow  fever  ;  a  mis- 
taken notion  relative  to  which,  more  than  its  ma- 
lignancy, spread  such  terror  and  consternation 
throughout  our  country." 

"  The  superiour  talents  of  the  conductors  of  the 
Medical  Repository  are  strikingly  exhibited  to 
the  most  superficial  observer,  by  comparing  the 
ordinary  editorial  remarks  and  prefatory  observa- 
tions of  each  volume,  with  those  connected  with 
other  works  of  the  kind.  They  shew  something 
very  different  from  what  we  generally  meet  with 
in  such  publications." 

"  Their  Reviews  also  shew  unusual  liberality 
and  candour  ;  a  masterly  comprehension  of  the 
subjects,  which  needed  not  that  little  hard  strained 
satire,  sarcasm  and  misrepresentation,  which  too 
many  of  those,  who  thus  assume  the  province  of 
directing  the  public  mind,  think  essential  to  their 
success  — The  Reviewers  of  the  Repository  pos- 
sessed not  that  disposition  which  could  not  abide 


Biographical  Sketch.  lxxxvii 

the  better  part ;  that  malignant  eye,  which  could 
not  bear  the  beauty  of  what  came  under  its  in- 
spection. They  were  not  seekers  of  evil  rather 
than  of  good  ;  they  had  no  malevolence  to  satisfy. 
No  ;  they  appeared  to  delight  in  discovering  and 
giving  publicity  to  the  valuable  works  of  others  : 
they  feared  not  to  give  praise  where  praise  was 
due.  If  their  liberal  conduct  upon  these  occa- 
sions, ever  gave  any  grounds  for  the  charge  of 
their  passing  more  lightly  over  the  errors  and  im- 
perfections of  authors,  than  strict  justice  to  the 
public  would  warrant,  it  shews  at  least,  that 
"  E'en  their  failings  lean'd  to  virtue's  side."  If 
in  an  instance  or  two,  in  the  earlier  periods  of  the 
reviews,  Dr.  Miller  indulged  rather  freely,  in  a 
vein  of  satire  and  severity  of  remark,  he  heartily 
condemned  it  afterwards.  I  have  heard  him  ex- 
press regret  at  the  circumstance,  as  being  no  way 
calculated  to  promote  the  views  of  science  or  the 
discovery  of  useful  truths.  His  subsequent  re- 
straint upon  the  talents  which  he  so  eminently 
possessed  in  that  way,  sufficiently  evince  the  sin- 
cerity of  his  professions." 

"  The  general  spirit  of  the  reviews  in  the  Re- 
pository were  highly  emblematical  of  the  disposi- 
tion of  Dr.  Miller.  Of  an  enlarged  and  liberal 
mind,  he  never  allowed  little  sectarian  or  partial 
prejudices  to  interfere  with  his  views  of  the  gene- 
ral good.     He  never  attempted  to  kindie  animosi- 


lxxxviii  Biographical  Sketch, 

ties,  nor  to  interrupt  the  promotion  of  others,  be- 
cause they  were  not  among  those  of  his  more  in- 
timate associates,  or  from  a  fear  that  it  might  di- 
minish his  own  consequence.  Far  !  far  different 
were  his  ideas  of  excellence.  Was  he  desirous  of 
distinction  ?  it  was  to  be  obtained  by  a  high  and 
honourable  spirit  of  emulation  only.  He  knew 
not  how  to  practise  a  double  part :  he  would  have 
shuddered  at  the  thought  of  attempting  by  treach- 
erous proffers  of  friendship,  to  wound  the  sensibi- 
lity of  unsuspecting  credulity.  But  why  dwell 
upon  these  mere  negative  virtues  ?  Dr.  Miller's 
character  rests  not  upon  the  mere  merits  of  not 
doing  harm.  It  is  founded  upon  a  life  spent  in  the 
employment  of  the  most  active  virtues.  The 
whole  scope  of  his  literary  exertions  seems  to 
have  been  directed  to  alleviating  the  sufferings 
and  relieving  the  diseases  of  his  fellow- creatures. 
His  daily  labour  was  in  dispensing  good  ;  nor  will 
any  one  suspect  him  of  being  governed  therein  by 
interested  motives.  His  inattention  to  his  pecu- 
niary concerns,  is  too  full  evidence  to  the  con- 
trary. He  seemed  never  to  think  of  money,  only 
as  his  immediate  necessities  required.  His  En- 
comiastic noticer  (in  the  Medical  Repository)  just- 
ly observes  of  him,  that  "  although  he  had  time 
"  enough  to  attend  to  every  thing  else,  he  had  no 
u  time  to  make  a  fortune."  He  rather  offended 
his  friends  by  neglecting  to  send  in  their  accounts, 
than  in  urging  remuneration  for  his  services." 


Biographical  Sketch.  lxxxlx. 

"  Dr.  Miller  never  dealt  in  slander  ;  he  never 
whispered  innuendoes.  In  all  our  intercourse  we 
never  knew  him  to  shrug  his  shoulders ;  never 
heard  him  say,  e?itre  nous,  or,  let  this  go  no  further. 
It  was  a  standing  rule  with  him  to  speak  ill  of  no 
man,  especially  of  those  of  the  profession,  unless 
the  common  good  demanded  it  of  him.  Hence 
he  conciliated  the  general  good  will  of  his  bre- 
thren The  honest  enquirer,  whose  opportunities 
had  not  furnished  equal  means  of  information  with 
himself,  was  always  sure,  however  ignorant,  to 
meet  a  friend  in  Dr.  Miller  ;  always  sure  of  gain- 
ing every  advice  and  instruction  that  his  extensive 
intelligence  could  afford  :  yet  the  bold  presuming 
empiric,  and  the  ignorant  impostor,  however  high 
they  might  stand  in  aniles  fabulte ,  however  esteem- 
ed and  favoured  by  the  credulous  multitude,  were 
ever  sure  to  meet  his  severe  censure  and  unquali- 
fied reprehension." 

"  In  acts  of  charity,  Dr.  Miller  was  constantly 
engaged ;  nor  was  it  his  personal  services  and  gra- 
tuitously dispensing  of  medicines  that  limited  their 
extent.  No  one  will  charge  him  with  sending 
away  pleading  poverty  unassisted  ;  and  yet  he 
never  spoke  of  his  alms-doings.  He  was  among 
those,  whose  disposition  it  is  "  to  do  good  by 
stealth  and  blush  to  find  it  fame."  Yet  notwith- 
standing his  great  care  to  keep  his  charitable  acts 
from  the  public  eye,  instances  are  not  wanting, 

m 


xc  Biographical  Sketch. 

where  meeting  with  poverty  and  disease,  he  turn- 
ed not  his  back,  nor  like  the  empty  professors  of 
old,  passed  by  on  the  other  side,  but  stopped  and 
administered  relief,  both  by  pouring  in  the  oil 
and  the  wine  of  his  professional  skill,  and  by  hav- 
ing them  otherwise  cared  for,  having  them  nursed 
and  boarded  at  his  own  expense.  What  shall  we 
say  of  this  modern  Samaritan  !  I  will  not  say  "  we 
ne'er  shall  see  his  like  again."  I  suspect  how- 
ever, we  seldom  meet  a  more  real  neighbour,  one 
of  more  disinterested  benevolence,  of  more  chris- 
tian love." 

"  In  a  moral  point  of  view,  the  character  of  Dr. 
Miller  was  irreproachable.  His  general  urbanity 
attracted  the  respect  and  attention  of  all  who  knew 
him.  Although  possessed  of  superiour  talents, 
he  was  modest  in  his  deportment  Although 
from  his  distinguished  reputation  as  a  physician, 
he  might  have  accumulated  wealth,  yet  was  he 
moderate  in  his  desires  :  possessing  an  ample  in- 
come, yet  betrayed  he  no  weakness  in  the  vanity 
of  equipage  :  ever  neat  in  his  person,  he  never 
gave  way  to  gaudy  pageantry  in  dress." 

"  In  what  related  to  his  own  particular  con- 
cerns, Dr.  Miller  was  habitually  reserved ;  hence 
his  views  and  sentiments  upon  the  subject  of  Re- 
ligion he  kept  very  much  to  himself.  I  am  au- 
thorized, however,  to  say,  that  "  he  always  deck- 


Biographical  Sketch.  xci 

red  himself  a  firm  believer  in  the  divine  origin  of 
Christianity,  and  reverenced  the  scriptures  as  a 
revelation  from  God.  This  was  particularly  mani- 
fested during  the  two  or  three  last  months  of  his 
life,  and  more  especially  in  the  course  of  his  last 
illness.  On  a  variety  of  occasions  he  discovered 
much  tenderness  and  seriousness  of  spirit  when 
speaking  on  the  subject  of  religion.  There  was 
scarcely  any  thing  which  he  more  disapproved, 
or  which  was  more  apt  to  excite  his  indignation, 
than  sneers  or  scoffing,  when  directed  against 
religion,  or  its  professors." 

"  I  am  assured  by  one  who  enjoyed  more  of 
his  conversation,  than  any  one  else,  that  "  he  never 
heard  a  profane  or  indecent  expression  from  his 
lips.  Probably,  said  he,  there  hardly  ever  lived  a 
man  whose  conversation  was  more  correct,  chaste 
and  guarded." 

"  I  know  not  that  I  ever  saw  a  person,  more 
temperate  than  he  was.  He  seldom  drank  any 
thing  stronger  than  water ;  and  he  discouraged 
the  use  of  ardent  spirits  both  by  precept  and  ex- 
ample, as  far  as  possible." 

"  The  delicate  and  affectionate  manner  in  which 
he  discharged  the  duties  which  he  owed  to  the 
more  immediate  circle  of  his  relatives  and  particu- 
lar friends,  is  above  all  praise.     He  was  in  the 


xcii  Biographical  Sketch. 

habit  of  annually  paying  a  visit  of  8  or  10  days  to 
his  sister  and  friends  in  Philadelphia.  His  nearest 
relative  in  this  city,  to  whom  he  had  rendered  him- 
self dear  beyond  measure,  never  hears  his  name 
mentioned  without  evidencing  the  most  affecting 
distress." 

"  Dr.  Miller  was  decided  in  his  political  prin- 
ciples. Hence  in  those  public  vehicles  of  slander, 
the  party  papers  of  the  day,  where  not  to  be  no- 
ticed, would  argue  either  want  of  consequence,  or 
a  suspicion  of  sincerity,  he  was  occasionally  assail- 
ed ;  but  never  with  violence.  Their  reptile  ma- 
nagers, cunning  as  serpents,  merely  spit  and  hiss- 
ed at  a  distance  :  they  never  dared  to  stick  their 
frangible  fangs  against  that  coat  of  mail,  which 
virtue  and  an  honest  integrity  had  wrought  around 
his  unblemished  reputation." 

"  Now  if,  with  Tully,  we  consider  real  glory  to 
consist  in  having  the  confidence  of  the  people,  in 
being  beloved  by  them,  and  in  their  considering 
us  worthy  of  honour,  then  indeed  must  the  life  of 
Dr.  Miller  have  been  truly  glorious  ;  for  by  them 
who  knew  him,  and  his  acquaintances  were  not 
a  few,  none  shared  more  confidence,  none  was 
more  beloved,  none  thought  more  deserving  of 
honour." 

"  Should  my  friendship  be  suspected  of  having 


Biographical  Sketch.  xciii 

estimated  him  too  highly,  it  cannot  but  be  acknow- 
ledged that  the  advantage  derived  from  a  long  and 
confidential  intercourse,  may  enable  me,  more 
than  many  others,  duly  to  appreciate  his  worth ;  for 
although  Dr.  Miller  was  affable  and  communica- 
tive where  occasion  required,  still  upon  the  whole 
he  might  be  considered  as  rather  retired  than  ob- 
trusive in  his  manner ;  and,  as  before  mentioned, 
in  whatever  related  to  himself  or  of  his  opinions, 
he  was  rather  reserved  than  ostentatious.  The 
nearer  he  was  approached,  the  better  he  appeared." 

"  With  a  sound  understanding,  well  stored 
with  knowledge,  mellowed  by  reflection  and  ex- 
perience :  and  with  a  disposition  so  well  directed 
to  employ  that  knowledge  to  the  best  of  purposes: 
enjoying  the  confidence  of  the  people  equal  to  the 
extent  of  his  exertions,  was  he,  while  engaged  in 
an  extensive  and  varied  usefulness,  thus  suddenly 
snatched  from  his  patients,  his  friends,  and  his 
profession.  We  perhaps  never  could  have  it 
more  fully  exemplified,  that  "  The  paths  of  glo- 
ry lead  but  to  the  grave,"  than  in  the  death  of  Dr. 
Miller.  Had  he,  during  the  incipient  stage  of  his 
disease,  been  more  attentive  to  his  own  health, 
and  less  solicitous  for  the  health  of  others ;  had 
he  consented  to  leave  his  patients  before  his  ex- 
hausted muscles  had  refused  to  transport  his  frame 
from  house  to  house,  ive  might  perhaps  not  now 
have  to  bemoan  the  loss  of  one  of  our  best  friends; 


xciv  Biographical  Sketch. 

his  patients  one  of  the  best  physicians  ;  the  medi- 
cal profession  one  of  its  greatest  ornaments.  But 
alas  !  my  friends,  this  friend  of  ours,  this  favoured 
friend  of  science,  this  friend  to  man,  is  no  more. 
My  friend,  my  colleague,  alas  !  is  fled  forever." 

"  He  who  each  virtue  fir'd,  each  grace  refin'd, 
"  Friend,  teacher,  pattern,  darling  of  mankind, 
"  Now  sleeps  in  dust." 

"  May  his  survivors,  the  companions  of  his 
life  inherit  a  double  portion  of  his  spirit!  May  the 
good  name  that  he  has  left — the  mantle  that  he 
dropped  at  his  departure,  enable  them  successfully 
to  emulate  his  virtues!" 

In  the  eulogy  pronounced  in  the  City-Hall,  at 
New-  York,  by  Doctor  Mitchill,  in  honour  of  Doc- 
tor Benjami?i  Rush,  on  the  8th  day  of  May,  1813, 
the  learned  orator,  after  having  mentioned  his  late 
colleagues,  Drs.  Smith  and  Miller,  as  gentlemen 
with  whom  the  deceased  professor  corresponded, 
and  in  whom  he  had  great  confidence,  thus  pro- 
ceeded.— 

if  Of  these  two  gentlemen,  thus  brought  to  nvy 
recollection,  permit  me  to  make  the  mention  that 
friendship  inspires.  With  them  both,  I  enjoyed 
that  virtuous  intercourse  which  renders  acquaint- 
ance delightful." 


Biographical  Sketch.  xcv 

"  The  former  (Dr.  E.  H.  Smith)  possessed 
a  mind  of  such  rare  and  exquisite  finish  ;  a  tem- 
per so  adapted  to  the  social  condition  ;  and  a  man- 
ner so  delicate  and  refined,  that  few  of  his  con- 
temporaries could  rival  him.  With  a  diligence 
which  left  him  few  lost  moments  to  regret ;  a 
method  that  placed  every  thing  he  knew  just 
where  it  ought  to  be  ;  and  an  application  of  his 
talents  to  do  all  the  good  in  his  power,  he  was  an 
ornament  to  the  time  in  which  he  lived.  Difficult, 
indeed,  would  it  be  to  find  such  another !" 

"  The  latter  (Dr.  Miller,)  also,  my  companion 
and  fellow  labourer,  in  undertakings  which,  to 
ourselves  at  least,  seemed  useful  and  advanta- 
geous, was  endowed  with  uncommon  qualities. 
His  head  was  a  treasury  of  information  ;  his  heart 
was  a  mine  of  beneficence.  With  a  rich  fund  of 
learning,  and  a  capacity  to  turn  that  acquirement 
to  the  best  account,  he  shewed  to  great  advantage 
in  the  most  respectable  circles.  His  professional 
career,  both  in  his  public  capacity,  and  his  private 
walks,  was  the  subject  of  such  commendation,  that 
the  calls  to  service  were  almost  incessant.  When 
such  excellence,  with  all  the  mildness  and  benig- 
nity which  adorned  it,  was  summoned  away,  it  is 
no  wonder  that  the  city  felt  a  disposition  to 
mourn." 

The  following  reference  to  the  funeral  of  the 


Xcvi  Biographical  Sketch. 

deceased,  from  an  unknown  hand,  appeared  in  one 
of  the  morning  papers  of  New-  York,  the  day  after 
that  event. 

"  Yesterday  afternoon,  was  interred  in  one  of 
the  vaults  of  the  new  Presbyterian  Church  in  this 
city,  the  mortal  part  of  Dr.  Edward  Miller.  The 
funeral,  for  the  number,  and  respectability  of  its 
attendants,  has  not,  we  believe,  been  equalled, 
since  the  interment  of  Gen.  Hamilton.  After  the 
procession  had  entered  the  Church,  the  body  was 
deposited  at  the  foot  of  the  pulpit,  and  remained 
there,  while  a  most  eloquent  and  pathetic  address 
was  delivered  by  the  Rev.  Dr.  Romev  n.  Every 
part  of  the  Church  was  crowded,  and  every  eye 
was  moistened,  by  sympathetic  feelings,  for  the 
irreparable  loss  sustained,  by  the  relatives  of  the 
deceased  ;  yet  the  extent  of  that  loss,  can  be  pro- 
perly appreciated,  only  by  those,  whose  intimate 
knowledge  of  him  has  afforded  them  an  opportuni- 
ty of  witnessing  his  conduct,  as  a  friend,  and  a 
brother.  We  have  said  that  sympathy  clouded  the 
brow  of  every  spectator  ;  but  a  more  selfish  feel- 
ing quickly  came  to  share  the  tear  it  excited. 
Every  one  mourned  the  loss  of  uncommon  talents, 
and  medical  eminence,  to  society  at  large.  Every- 
one regretted  that  the  light  which  had  guided  the 
junior  professors  of  the  healing  art,  was  so  soon 
extinguished." 


Biographical  Sketch.  xcvh 

The  following  paragraphs  are  from  the  pen  of 
professor  Hosack,  and  make  a  part  of  a  biographi- 
cal sketch  contained  in  the  Medical  and  Philoso 
phical  Register,  a  valuable  periodical   work,    oi 
which  that  gentleman    is  the  principal  editor. 
This  honourable  testimony  to  the  character  of 
Doctor  Miller  will  be  the  more  highly  appreciated, 
when  it  is  recollected,  that  it  comes  from  one  who 
essentially  differed  from  him  in  opinion  on  a  great 
medical  question,  and  who  has  more  than  once 
appeared  before  the  public  as  a  professional  anta- 
gonist.    This  circumstance  also,  while  it  gives 
additional  weight  to  the  testimony  in  question,  ex 
hibits  in  a  light  which  will  not  be  overlooked,  the 
magnanimity  by  which  it  was  dictated. 

"  From  the  review  of  the  life  and  literary  la- 
bours of  Dr.  Miller,  let  us  now  turn  to  a  conside- 
ration of  his  character.  Whether  we  consider  Dn 
Miller  as  a  physician  or  as  a  man  ;  whether  in  the 
walks  of  public  or  in  private  life,  he  has  equal 
claims  to  our  respect  and  admiration.  Endowed 
by  nature  with  a  mind  at  once  quick  in  its  percep- 
tions and  comprehensive  in  its  views,  and  with  a 
memory  extremely  retentive  and  accurate,  he  ac- 
quired, from  his  great  thirst  for  knowledge  and 
devotedness  to  study,  an  intimate  acquaintance 
with  the  science  of  medicine*     From  his  profj 

*  Vol.  Ill,  p   c 
h 


xcviii  Biographical  Sketch. 

ciency  in  the  Greek  and  Latin  languages,  and  in 
those  of  modern  Europe,  he  was  enabled  to  obtain 
ready  access  to  the  treasures  of  knowledge  con- 
tained in  the  writers  of  those, nations.  This  know- 
ledge he  particularly  displayed  in  his  public  in- 
structions as  a  teacher.  Of  his  merits,  in  the  im- 
mediate exercise  of  the  duties  of  his  profession,  it 
is  unnecessary  to  enter  into  any  minuteness  of  de- 
tail. To  his  comprehensive  knowledge,  he  added 
a  patient  attention  to  the  safety  of  those  commit- 
ted to  his  care,  and  ever  retained  a  high  sense  of 
the  responsibility  attached  to  the  medical  charac- 
ter. To  an  address  the  most  engaging,  from  a  hap- 
py union  of  dignity,  respectfulness,  and  ease,  was 
added  a  gravity  of  deportment  that  evinced  a  due 
concern  for  the  distresses  of  those  whom  he  was 
called  upon  to  relieve.  The  kindred  sympathy 
which  his  feelings  constantly  manifested,  and  the 
encouragement  and  consolation  which  the  sensi- 
bility of  his  heart  and  the  resources  of  his  culti- 
vated mind  always  supplied,  enabled  him  to  dis- 
charge the  double  duties  of  the  friend  and  physi- 
cian, and  alike  to  minister  relief  to  the  afflictions 
of  the  mind,  with  no  less  efficacy  than  to  the  dis- 
eases of  the  body." 

"  The  distinction  which  Dr.  Miller  attained  did 
not  depend  upon  his  acquaintance  with  those  bran- 
ches of  knowledge  only  which  belong  to  his  pro- 
fession ;  they  indeed  were  the  objects  of  his  pri- 


Biographical  Sketch.  xcix 

mary  attention,  but  there  were  other  objects  of 
which  he  was  far  from  being  neglectful.  Believ- 
ing that  liberal  and  elegant  studi  s  give  additional 
lustre  to  character,  and  e  nnobk  professional  repu- 
tation, he  devoted  a  considerable  portion  of  his 
time  to  the  acquisition  of  general  science  and  the 
ornamental  parts  of  literature.  From  his  writings, 
an  idea  may  be  formed  of  his  literary  qualifications, 
and  his  various  accomplishments  as  a  scholar. 
Their  chief  object  was  a  defence  of  the  doctrine 
of  the  domestic  origin  of  yellow  fever,  and  the  non- 
contagious  nature  of  that  disease ;  a  doctrine  of 
which  he  and  Dr.  Rush  are  acknowledged  the  most 
zealous  and  successful  advocates." 


si  Pergama  dextra 

Defendi  possent,  etiam  hac   defensa   fuissent. 

"  We  have  already  discussed  the  subject  at 
some  length  in  the  preceding  volumes  of  the  Re- 
gister ;  we  have  stated  our  opinions  with  an  ear- 
nestness arising  from  the  deepest  conviction  of 
their  correctness,  and  we  believe  that  the  facts 
and  arguments  we  have  adduced  fully  justify  the 
matter  of  our  remarks.  In  the  warmth  of  discus- 
sion some  hasty  expressions  may  have  escaped  us ; 
but  we  recant  not  an  iota  from  any  thing  we  have 
said  material  to  the  controversy." 

"  But  however  highly  Dr.  Miller  was  to  be  ad- 


6  Biographical  Sketch. 

mired  for  the  endowments  of  his  understanding 
and  his  various  attainments  ;  the  sentiments  of  af- 
fection and  esteem  are  more  forcibly  excited  by 
the  exalted  qualities  which  adorned  his  moral  na- 
ture. In  every  relation  of  life,  both  public  and 
private,  he  was  uniformly  guided  by  principles  of 
the  purest  integrity.  No  man  seems  to  have  been 
more  sensible  of  the  dignity  of  his  profession,  and 
no  one  was  ever  more  guarded  lest  that  dignity  be 
sullied.  In  his  political  opinions  he  was  uniform 
and  decided  ;  yet  the  spirit  of  party  never  so  far 
influenced  him  as  to  become  the  mountebank  po- 
litician. Such  conduct  he  considered  incompati- 
ble with  the  character  of  a  physician.  His  fellow 
citizens  manifested  a  grateful  sense  of  his  worth, 
and  appointed  him  for  a  series  of  years  to  an  office 
of  high  respectability.  Despising  the  low  artifices 
by  which  many  obtain  professional  practice,  he 
was  distinguished  for  his  fine  sense  of  propriety 
and  honour  in  his  intercourse  with  his  brethren  of 
the  faculty.  The  writer  of  this  imperfect  sketch, 
who  has  often  witnessed  his  delicacy  in  this  res- 
pect, would  do  injustice  to  his  own  feelings  were 
he  not  to  state,  that  his  deportment  conciliated  the 
affection  of  all,  and  is  worthy  of  universal  imita- 
tion. As  a  philanthropist,  he  exercised  an  ex  ten 
sive  charity  to  the  poor  in  gratuitous  medical  ser- 
vices. It  were  needless  to  dwell  upon  his  charac- 
ter, as  displayed  in  the  circle  of  his  immediate 
friends,  whom  the  ties  of  consanguinity,  or  whom 


Biographical  Sketch.  ci 

similar  inclinations  and  pursuits  had  united  in  the 
bond  of  friendship.  He  evinced  all  the  energies  of 
social  affection  ;  he  loved  with  all  the  warmth  of 
fraternal  kindness." 

Nor  can  the  writer  of  this  sketch  deny  himself 
the  pleasure  of  inserting  the  following  tribute  of 
respect,  from  the  pen  of  William  Dunlap,  Esq.  one 
of  the  earliest  acquaintances  and  friends  whom 
Doctor  Miller  gained  on  removing  to  New-  York. 
It  is  extracted  from  a  literary  work  of  real  merit,* 
of  which  he  is  the  conductor. 

"  Few  men  have  passed  through  life  more  free 
from  the  frailties  of  our  nature,  than  Doctor  Ed- 
ward Miller.  Few  men  have  possessed  so  many 
virtues,  so  pure,  so  strong,  and  so  unclouded." 

"  Of  his  talents  and  acquirements  as  a  physician 
I  have  spoken  ;  but  his  praise  stops  not  there. 
His  kind  solicitude,  his  patient  attention,  his  sym- 
pathizing with  the^  sufferings  of  those  whom  duty 
and  feeling  prompted  him  to  relieve,  were  as 
valuable  to  the  sick  as  his  skill.  He  did  not  feel 
a  pulse  and  look  at  a  tongue,  with  the  affected 
gravity  of  sage  stoicism,  then  write  a  prescription, 
and  hurry  to  the  next  patient  upon  the  list ;  but  he 
tenderly  inquired  and  anxiously  sought  for  the 

*  Monthly  Recorder.    Vol.  I,  p.  10. 


cii  Biographical  Sketch. 

seat  and  source  of  pain  ;  and  while  his  dignified 
deportment  and  easy  manners  conciliated  the  mind 
of  the  sufferer,  the  interest  he  so  obviously  took, 
inspired  confidence,  and  tended  more  to  restore 
hope  and  health,  than  even  the  medicine  his  ex- 
perience recommended.  To  the  convalescent,  his 
visits  were  particularly  useful,  for  there  is  nothing 
so  cheering  to  the  tedious  hours  of  a  sick-room, 
as  the  animating  conversation  of  a  beloved  phy- 
sician, who  with  the  news  of  the  day  or  the  anec- 
dote of  the  drawing-room,  mingles  the  observa- 
tions of  the  philosopher,  and  the  criticisms  of  the 
man  of  taste.  All  this,  Doctor  Miller  brought  to 
the  chamber  of  the  recovering  patient,  to  perfect 
the  cure  his  skill  and  his  tenderness  had  begun." 

u  Asa  literary  man,  Doctor  Miller  stood  high. 
With  a  mind  uncommonly  quick  to  perceive,  to 
discriminate,  and  combine,  and  equally  powerful 
to  retain,  he  had  acquired  a  mass  of  well- selected 
and  well- arranged  knowledge,  which  he  commu- 
nicated in  a  style  of  attic  purity  and  elegance." 

"  His  habits  were  those  of  the  strictest  tem- 
perance. His  appearance  indicated  that  neatness 
and  praise-worthy  attention  to  dress,  which  cor- 
responded with  the  purity  of  his  mind,  and  the 
unvaried  propriety  of  his  manners." 

M  His  manners  were  truly  those  of  a  gentleman. 


Biographical  Sketch.  ciii 

Unassuming  without  any  marks  of  timidity  or 
mauvaise  honte ;  reservedly  polite  with  those 
whom  he  did  not  know,  or  whom  he  knew  to  be 
unworthy  of  his  confidence  ;  but  frank  and  open 
as  the  day  to  those  with  whom  he  felt  the  sym- 
pathy of  congenial  intellect.  His  conversation, 
though  easy,  suffered  a  little  from  a  hesitancy 
which  appeared  to  have  originated  in  a  scrupulous 
delicacy  of  taste  respecting  the  choice  of  words 
and  phraseology.  Delicacy,  in  every  part  of  his 
character,  was  a  prominent  feature  :  a  feature  in- 
dispensably necessary  in  the  character  of  a  gen- 
tleman." 

"  Doctor  Miller  was  never  married.  His  do- 
mestic circle  were  his  beloved  brother  and  sisters 
and  their  children.  His  attachment  to  his  rela- 
tives increased  to  the  day  of  his  death.  He  lived 
for  his  friends  and  for  the  world,  without  a  thought 
of  accumulating  wealth,  at  the  same  time  knowing 
that  wealth  comparatively  great  to  the  wants  of  a 
philosophic  mind  was  secured  to  him.  His  do- 
mestic arrangements  were  characteristic,  and  his 
apartments  were  ornamented  by  the  indications  of 
his  pursuits ;  every  table  and  sofa  displaying  ma- 
nuscripts, pamphlets,  and  volumes,  collected  by 
his  industry,  or  flowing  as  tributes  to  his  talents.'1 

"  Every  class  of  men  joined  in  sympathetic  re- 
gret, and  in  mournful  testimonials  to  his  superiom 


civ  Biographical  Sketch* 

worth.  The  assemblage  of  citizens,  who  attend- 
ed to  pay  the  last  tribute  of  love  and  respect  to  his 
mortal  remains,  was  numerous  beyond  example, 
except  in  the  instance  of  the  funeral  of  General 
Hamilton,  whose  death  not  only  excited  an  extra- 
ordinary sensation,  from  the  loss  of  a  great  and 
distinguished  military  and  political  leader,  but 
from  the  manner  and  cause  of  his  dissolution.  In 
the  instance  I  am  recording,  the  uncommon  con- 
course, not  only  of  spectators  but  of  mourners, 
was  unexpected;  for  the  tribute  of  sorrow  was  paid 
to  a  man  whose  actions  were  not,  like  Hamilton's, 
exposed  to  the  gaze  of  millions,  but  were  confined 
to  the  abodes  of  sickness  or  the  retreats  of  medi- 
tation. The  expression  of  grief  was  strong  and 
universal :  but  there  were  hearts  who  felt  the  pri- 
vation too  keenly  for  expression.  They  had  lost 
the  best  of  friends  and  the  best  of  brothers." 

After  this  honourable  testimony,  from  so  many 
sources,  but  little  is  left  to  be  added,  even  by  the 
pen  of  fraternal  partiality.  A  few  additional  re- 
marks, however,  will  be  attempted,  chiefly  with 
the  view  of  enlarging  several  parts  of  the  portrait 
which  have  been  already  sketched,  and  which  ap- 
pear worthy  of  being  contemplated  a  little  more 
distinctly. 

The  uniform  integrity  and  unsullied  honour  of 
Doctor  Miller,  have  been  alreadv  noticed  in  a  cur- 


Biographical  Sketch.  cv 

sory  manner,  by  several  of  his  panegyrists.  They 
were,  indeed,  peculiarly  exemplary,  and  worthy  of 
imitation.  From  his  earliest  youth,  he  appeared 
not  only  to  abhor  every  thing  directly  and  openly 
dishonest  ;  but  also  recoiled,  with  the  most  deli- 
cate sense  of  moral  obligation,  from  every  species 
of  intrigue  and  underhanded  dealing.  If  any 
measure  which  approached  to  this  character  were 
proposed  in  any  association  of  which  he  was  a 
memoer,  he  never  failed  to  express,  in  some  way, 
his  entire  disapprobation  of  it,  and  utterly  to  de- 
cline taking  any  part  in  its  execution.  Nor 
could  any  thing  more  decisively  induce  him  to 
take  a  final  leave  of  such  an  association  than  the 
discovery,  that  it  was  beginning  to  be  the  theatre 
of  cabal,  or  of  any  kind  of  crooked  policy. 

This  quality  which  appeared  in  all  the  social 
and  professional  conduct  of  Doctor  Miller,  shone 
with  peculiar  lustre  in  his  political  character.  He 
was  a  decided  and  uniform  Republican  That  is, 
he  was  a  warm  friend  to  popular  and  free  govern- 
ment ;  and  approved,  in  the  main,  of  those  ad- 
ministrations which  have  successively  swayed  the 
counsels  of  our  country  for  the  last  twelve  years. 
Nor  was  he  backward  to  avow  this.  Though 
characteristically  prudent  and  cautious,  he  made 
no  secret  of  his  political  opinions.  In  all  cases  in 
which  he  was  called  to  speak  or  act,  it  was  with 
the  most  unreserved  openness  and  decision.  Yet  it 

o 


cvi  Biographical  Sketch. 

may  safely  be  asserted,  that  he  never  lost  a  friend 
from  political  considerations.  He  maintained  his 
opinions  with  so  much  mildness,  and  deference  to 
those  of  others  ;  so  carefully  avoided  every  thing 
justly  offensive,  either  in  speech  or  action  ;  and 
treated  those  who  differed  from  him  with  so  much 
urbanity,  that  animosity  was  disarmed  in  his  pre- 
sence. He  seldom  attended  political  meetings  ; 
because  he  hated  strife  and  violence.  He  never 
harangued  on  politics  in  porter-houses  or  club- 
rooms  ;  because  he  had  too  j  ust  a  sense  of  the  prin- 
ciples of  free  government,  and  too  much  self-res- 
pect, to  adopt  this  method  of  propagating  his 
opinions.  He  was  never  heard  to  impute  disho- 
nest views  or  motives  to  political  men,  unless  in 
cases  of  the  most  evident  and  unquestionable  wick- 
edness. By  far  the  greater  number  of  those  friends 
with  whom  he  maintained  the  most  intimate  and 
affectionate  intercourse,  and  whose  unbounded 
confidence  he  enjoyed,  embraced  a  different  creed 
on  this  subject  from  himself.  Seldom,  very  sel- 
dom, has  there  been  seen  a  more  pleasing  example 
than  his  conduct  afforded,  of  that  deportment  as  a 
politician,  which,  without  relinquishing  principle, 
cherishes  peace  and  good  will ;  and  which,  if  it 
were  universal,  would  banish  party  violence  and 
intolerance  from  the  earth. 

Doctor  Miller's  delicacy  in  conversation  has  been 
seldom  equalled  ;  never  surpassed.     Nothing  ever 


Biographical  Sketch.  cvii 

escaped  from  his  lips,  even  in  his  most  unreserved 
moments,  to  which  the  most  refined  and  scrupulous 
might  not  listen  without  offence.  This  was  the 
case,  even  in  those  periods  of  his  life  when  he  was 
less  under  the  influence  of  religious  principle, 
than  during  its  later  stages.  To  say  any  thing 
which  might  tinge  the  cheek  of  modesty,  or 
wound  the  ear  of  piety,  he  considered  as  unworthy 
of  a  gentleman,  as  it  was  criminal. 

Nor  was  his  temperance  less  conspicuous  than 
his  delicacy.  He  not  only  avoided  the  use  of  ardent 
spirits  with  a  scrupulousness,  which  to  some 
might  appear  excessive ;  but  he  was  unusually 
sparing  and  even  abstemious  in  the  use  of  every 
kind  of  strong  drink.  He  carefully  avoided  the 
use  of  tobacco,  in  every  form,  not  only  as  an 
odious  and  unhealthful  practice ;  but  also  as  a 
most  insidious  provocative  to  the  love  of  drinking. 
Nor  was  his  temperance  confined  to  a  single  class 
of  stimuli.  It  was  no  less  conspicuous  and  ex- 
emplary with  respect  to  all  the  indulgences  of  the 
palate.  The  writer  has  no  recollection  of  having 
ever  seen  a  man,  especially  one  who,  from  his  pub- 
lic station,  was  called  to  mingle  so  much  with  all 
classes  of  society,  who  was  more  uniformly  rigid, 
or  who  exercised  a  more  sacred  and  successful 
self-command,  with  respect  to  this  point,  than 
Edward  Miller. 


ex  Biographical  Sketch. 

On  another  occasion,  a  still  longer  time  before 
his  decease,  at  the  house  of  a  pious  friend,  after 
considerable  conversation  on  serious  subjects,  he 
remarked,  with  energy  and  feeling,  "  that  he  was 
"  fully  convinced,  no  man  could  enjoy  real,  solid 
"  happiness  in  this  world,  until  he  was  brought 
"  cordially  to  embrace  the  Gospel  of  Jesus  Christ, 
"  and  humbly  to  repose  in  his  atoning  blood,  and 
"  his  precious  promises,  as  the  hope  of  his  soul." 

A  few  weeks  before  his  own  decease,  he  lost  by 
death  a  favourite  Nephew.  The  unusual  serious- 
ness which  he  manifested  on  this  occasion  ;  the 
interest  which  he  appeared  to  take  in  the  religious 
exercises  which  attended  the  mournful  bereave- 
ment ;  and  the  peculiar  tenderness  of  feeling  which 
he  discovered  in  referring  to  the  eminent  piety 
and  heavenly  blessedness  of  his  honoured  parents, 
in  following  the  remains  of  his  little  relative  to  the 
grave,  will  never  be  forgotten  by  those  who  in- 
timately witnessed  them. 

Accordingly,  during  his  last  illness,  when  he 
was,  for  some  days,  apparently  convalescent,  the 
Bible  was  almost  the  only  book,  which  he  attempt- 
ed to  read.  From  the  hour  in  which  he  was 
apprehended  to  be  in  danger,  he  was  incapable  of 
either  reading  or  conversation. 

The  only  remaining  feature  of  Doctor  Miller's 


Biographical  Sketch.  cxi 

character  to  which  any  reference  will  be  attempted, 
is  the  singularly  engaging  and  exemplary  manner 
in  which  he  recognized  the  duties  of  domestic 
relation.  His  filial  and  fraternal  affection  can 
never  be  too  much  praised. — But  on  this  subject 
the  writer  of  the  present  sketch  dares  not  trust  his 
own  feelings.  He  has  seen  so  much,  and  experi- 
enced so  much  of  the  affection  and  kindness  of 
which  he  speaks,  that  if  there  be  any  department 
of  his  undertaking  in  which  he  has  reason  to  im- 
pose a  double  guard  upon  himself,  it  is  here.  And 
after  all,  he  has  little  doubt  that  a  representation 
which  should  do  nothing  more  than  justice  to  the 
memory  of  his  beloved  Relative,  would  be  con- 
sidered, by  those  who  were  unacquainted  with 
that  Relative,  as  extravagant.  He  is  persuaded, 
however,  that  those  who  knew  him  best,  will  be 
most  ready  to  justify  the  strongest  delineation  of 
this  part  of  his  character. 


DISSERTATIO  MEDICA, 

INAUGURALIS, 

DE 

PHYSCONIA  SPLENICA. 

quAM 
SUB  MODERAMINE  VIRI  ADMODUM  REVEREND1 

D.  JOANNIS  EWING,   S.  S.  T.  P. 

UNIVERSITATIS    PENNSYLVANIENSIS    PR.EFECTI  ; 

EX   CURATORUM   PERILLUSTRIUM    AUCTORITATE, 

NEC    NON 

AMPLISSIMiE  FACULTATIS  DECRSTO, 

DEO  MAXIMO  ANNUENTE, 

PRO  GRADU  DOCTORATUS, 

SUMMISQUE   IN  MEDICINA  IIONORIBUS    ET   PRIVILEGIIS   RITE 

ET    LEGITIME    CONSEQUENDIS  ;    ERUDITORUM 

EXAMINI    SUBJECTAM    SUSTINUIT 

EDVARDUS  MILLER,  M.  B, 

DELAVARENSIS, 

SOCIETAT.    MED.    DELAVARENS.    S01» 
EJUSDEMQUE    A    SECRETIS, 
AD    DIEM    23.    JUIill,    HORA    LOCOQ.UE    SOLITi^. 


L   Impatience  du  mal,   Pamourdelg  vie,l 'horreurde  la  mort,  sentiments 
issi  naturela  c;t;e  celui  de  notre  existence,  firent  chercher  aim  lioumies  la. 
guerigon  de  lews  maux. 


V1R0  EXCELLENTISSIMO 


JOSUiE    CLAYTON, 


ARMIGERO, 


REIPUBLIGE    DELAVARENSIS 


PR^SIDI    DIGNISSIMO, 


\D    TANTUM   HONORIS    FASTIGIUM, 


MERITIS,   AC    VIRTUTIBUS, 


EVECTO, 


PROPTER    INSIGNEM    IN    RE    MEDItA 


SCIENTIAM    AC    PERITIAM, 


ET    AMICITIAM    ERGA    SE    SINGULAREM 


:\EC  INO.X 


VUIO  CLARISSIMO 


MEDICO  CELEBERRIMO, 


JACOBO  TILTON,  M.  D. 


SOCIETAT.  MED.  DELAY ARENSIS 


PRjESIDI, 


SOCIETAT.  PHILOSOPHISE  AMERICANS 


SOCIO, 


OB    AMICITIAM    INTEMERATAM,    QUA    SE, 


AB    INITIO   USQUE    STUDIORUM,    PUIT    DIGNATUS, 


ET    PROPTER    MAGNA   IN    SE,    SUOSQUE, 


COLLATA   EENEPICIA: 


DENIQUE 
VIRO  ORNATISSIMO 

NICOLAO  WAY,  M.  D. 

SOCIETAT.  MED.  DELAVARENSIS 
E  CENSORIBUS, 

SOCIETAT.  PHILOSOPHIC^  AMERICANS 

SOCIO, 

VIRTUTIBUS,    Q.UJE    CIVEM,    HOMINEMQUE 

EXORNANT, 

NON    MINUS    Q.UAM    ERUDITIONE, 

AC    SCIENTIjE    AMORE,    INSIGNI ; 

ARTEM   HIPPOCRATICAM 

SUMMA    ET    MERITA    CUM    LAUDE, 

APUD    WIL.MINGTONIENSES    EXERCENTi; 

HANC    DISSERTATIONEM    MEDICAM    INAUGURALEM, 

UT    OBSERVANTIjE    SUMMiE    TESTIMONIUM    EXIGUUM, 

-iACRAM    ESSE    VOLUIT 

MJCTOR. 


DISSERTATIO  MEDICA, 

INAUGURALIS, 


DE 


PHYSCONIA  SPLENICA, 

INTER  morbos,  quibus  gens  humana  vexatur, 
quidam,  prse  aliis,  attentionem  medicorum  meren- 
tur.  Ex  effectibus,  vero,  quos  edunt,  Dolor  et 
Mors,  procul  dubio,  gravissimi  sunt.  Hinc 
morbi,  quos  comitatur  dolor  acerrimus,  et  qui- 
bus est  proclivitas  in  mortem  prasceps,  humano 
generi  nunquam  non  terrorem  incutiunt  ;  atque 
hinc  homines,  omnibus  in  seculis,  medicinam, 
plus  minus,  excoluerunt.  Hisce  quoque  morbo- 
rum  effectibus,  sasvis  quidem  et  lugendis,  cona- 
tus  validiores  et  indefessos,  atque  ardorem  pene 
incredibilem  ad  medicinam  promovendam  et  au- 
gendam,  debemus  ;  ex  his,  denique,  ut,  quodam 
sensu,  tuto  affirmare  liceat,  proveniunt  honores 
omnes,  et  emolumenta  quae  ars  nostra  salutifera 
est  unquam  asseeuta. 

Etsi  dolorem  lenire,  et  mortem  minus  frequen- 
tem  reddere,  sit  meta  optatissima,  atque  dignissi- 
ma,  quam  Ars  Medica  attingere  possit ;  tamen 

B 


10  Dissertatio  Inauguralis. 

alia  sunt,  eaque  gravissima,  ad  qua?  medicum 
semper  respicere  oportet.  Mala  quibus  laborant 
homines  leniora,  quae  eos  ad  vires  corporis  alacri- 
ter  et  strenue  exercendas  minus  aptiores  red- 
dunt;  etiam  quse  corporis  formam  justam,  pul- 
chram  et  concinnam  vitiant ;  quae,  denique,  pro 
ore  rosaceo,  et  lumine  sanitatis  purpureo,  vultum 
pallidum  et  figurae  maciem  inducunt  ;  aliaque 
bene  multa,  levioris  quasi  momenti,  conatus  artis 
nostras  optimos  postulant. 

Morbus,  de  quo  nunc  agendum  est,  plerisque 
saltern  in  casibus,  neque  periculum,  neque  dolo- 
rem  gravem  minitatur.  Satis  vero  amborum  ali- 
quando  gignit,  adeo  ut  eum  attentione  medicorum 
esse  indignum,  nequaquam  concludere  liceat.(a) 
Exempla  hujus  mali,  hac  in  regione,  frequentissi- 
ma ;  deformitas  faeda  quam  corpori  humano  in- 
ferre  solet ;  indoles  ejus  chronica,  molesta,  atque 
accumulans  •,  observationes  innumerae  quae  osten- 
dunt  quam  sit  pertinax  et  sanatu  difficilis  ;  et  de- 
nique hoc  argumentum  accuratius  cognoscendi, 
studium,  occasionem  dedere,  cur  id,  inprassentia, 
seligendum  putavi. 

Quam  difficile  sit  hujus  tentaminis  argumen- 
tum, haud  equidem  ignoro,  neque  minus,   quam 

(a)  Strack.  Observ.  Med.  de  Febr.  Interm.  apud  Duncani 
Comment.  Decad.  2.  Vol.  2.  P.  132. 


Dissertatio  Inaugurate.  11 

sit  mihi  curta  supellex  ad  difficiliora,  ca  qua  par 
est,  perspicacitate,  tractanda.  Aggressus  vero 
fui,  non  tarn  spe  illustrandi  obscura,  consiliovc 
commenta  nova  proponendi,  quam  ut  probabiliora 
de  qusestione  medicinas  dubia  perdiscere  con- 
arer. 

Morbi  genus,  quod  speciem,  de  qua  nunc  agi- 
tur,  inter  multas  alias  sibi  invicem  dissimiles, 
complectitur,  apud  Nosologos(6)  Physconia  appel- 
lator. De  omnibus  speciebus,  ad  hoc  genus  per- 
tinentibus,  tractare,  a  proposito  hujusce  disser- 
tationis  alienum  foret.  Physconiam  vero  Spleni- 
ca™, peculiarem  sibi  naturam  vindicare,  atque 
idcirco  tractationem  seorsum  mereri,  ostendere 
conabor. 

Ex  morbis,  qui  chronici  appellantur;  non  pau- 
ci  suat,  qui  aegre,  difficilime,  et  saspe  infeliciter, 
a  medicis  curantur.  Mala,  enim,  quas  a  langui- 
do  humorum  motu  profluunt,  eo  lentius  et  diffici- 
lius   sanantur,    quod  omnes   simul  natural  vires 

(b)  Hujus  vocabuli  Etymologia  minime  in  dubio  est.  Phys- 
conia a  *TSKi2N,  ventricosus,  derivatur ;  quod  ab  <J>Y£A& 
inflo,  deducitur. — Ptolemceus  Euergetes  secundus  banc  ap- 
pellationem  adeptus  est.  Strabo  eum  Physconem  nominat 
hoc  est  ventricosum.  Erat  enim  et  vultu  deformis,  et  statua 
brevis,  et  sagina  ventris  non  homini,  sed  belluae  similis. — Jus- 
tini  Lib.  xxxviii.  cap.  viii. — Antient  Universal  History,  Vol. 
9.  P.  98.     Tit.  Liv.  &c. 


12  Dissertatio  Inauguralis . 

deficiunt.  Quae,  vero,  a  nimio  humorum  impetu 
proveniunt,  iis  aut  mors  cita,  aut  victoria  lastaj, 
brevi  finem  imponit.(c) 


DEFINITIO. 

Celeberrimi  auctores,  Sauvagesius,  Linnae- 
us, Vogelius,  et  Cullenus.  Physconice  et  Hyposar- 
c<£  titulis,  varie,  in  suis  egregiis  operibus  noso- 
logicis,  id  genus  morbi,  cujus  haec  est  species,  de 
qua  nunc  agitur,  definiverunt. 

Definitio  Sauvagesiana,  viz.  "  Intumescentia 
abdominis  a  partibus  solidis,  sine  graviditate  et 
fluctuatione.'' 

Ut  Vogelio  placit,  "  Intumescentia  abdominis 
longa,  a  magnitudine,  habituve  visceris  mutato." 

.  Linnaeana  Definitio,  viz.  "  Abdominis  nodosa 
intumescentia.'' 

Inter  memoratos  nosologic  cultores  illustrissi- 
mos,  nemo  hunc  morbum  tarn  bene  definivit 
quam  doctissimus  Cullenus,  qui  characterem 
suum  verbis  quae  subsequuntur  tradendum  cu- 
ravit.     "  Tumor  quandam  abdominis  partem  po- 

(c)  Greg.  Conspect.  Med.  Theoret, 


Dissertatio  Inauguralis.  13 

tissimum  occupans,  paulatim  crescens,  nee  so- 
norus  nee  fiuctuans." 

Sed  in  Physconia  Splenica  ordinanda,  his  auc- 
toribus  clarissimis  dissentire  cogor. — Pace,  ita- 
que,  horum,  aliorumque  haud  parvi  nominis,  quos 
nemo  magis  quam  cgometipse  miratur,  quod  mi- 
hi  videtur,  ea  verecundia  qua  decet,  nunc  paucis 
verbis  proferam. 

Hoc  malum  ex  febribus  intermittentibus  origi- 
nem  ducere  fere  semper  videtur.  Omnium  medi- 
corum  consensu,  qui  hunc  morbum,  hac  in  re- 
gione,  frequentissime  observant,  aeque  ac  obser- 
vationibus  propriis  multis,  in  hoc  propositum 
spectantibus,  rem  ita  se  habere,  vix  dubitare  pos- 
sum. Exempla  ejus  rarissima,  ex  aliis  causis, 
ut  videri  possit,  oriundi,  ad  evertendam  opin- 
ionem  tarn  verisimilem,  haud  facile  admittere 
licet.  Casus  hujusmodi,  febribus  nimirum  inter- 
mittentibus non  manifeste  praegressis,  aliquando 
vidisse,  lubenter  fateor.  Tales  vero  plerumque 
ea  anni  tempestate,  scilicet  autumno,  qua  febres 
nostrae  endemicse  grassari  solent,  oriuntur ;  et 
ergo  cognationem  cum  illis  plane  ostendunt. 
Physconiam  enim  Splenicam  posse  provenire  ex 
ejusdem  diatheseos  minore  gradu,  quam  qui  ad 
febres  intermittentes  revera  inducendas,  sufficiat, 
pro  comperto  habeo. 


14  Dissertatio  Inauguralis. 

His  positis,  si  normis  nosologic  methodica? 
obtemperare  velimus,  Physconiam  Splenicam, 
ut  speciem  morbi  distinctam,  agnoscere  neuti- 
quam  iicebit.  Hoc  consiiio  inductus,  et  minime 
mearum  virium  fiducia  suffultus,  definitionem, 
seu  potius  descriptionem  sequentem  nunc  aggre- 
dior. 

Febrium  intermittentium  plerumque  sequela; 
tumor  in  regione  Hypochondrii  simstri  exortus  ; 
paulatim  crescens ;  durus ;  scepe  indolens  ;  nee 
sonorus,  nee  fluctuans  ;  quandoque  huge  et  late 
diffusus  ;  et  diutissime  permanens. 

HISTORIA. 

Hie  morbus  infantes  recens  natos  rarissime  oc- 
cupat ;  pueros,  vero,  potissimum  a  tempore,  quo 
a  lacte  depelluntur,  ad  aetatem  puberem,  seepis- 
sime  infe6tat.  Qui  pubertatem  superaverunt, 
minorem  proclivitatem  ad  hoc  malum  quotannis, 
usque  ad  annum  vigesimum,  aut  circiter,  osten- 
dunt.  yEtate  provectiores  aliquando,  sed  rarius, 
vexare  solet.  Quibus  est  corporis  constitutio  de- 
bilis,  laxa  et  delicata ;  et  foeminae  multo  frequen- 
tius  quam  mares,  huic  morbo  objiciuntur.  Qui 
victu  utuntur  tenui  et  parco,  et  qui  variis  inopias 
difficultatibus  et  sordibus  premuntur,  huic  malo 
maxime  fiunt  obnoxii.  E  contrario,  qui  cibo 
vescuntur  pleno,  nutriente  et  lauto,  et  qui  rebus 


Dissertatio  Inauguralis.  15 

secunclioribus  fruuntur,  ab  illo,  aliqua  saltern  ex 
parte,  expertes  vivunt. 

Morbus  plerumque  invadit  autumno,  vel,  ea 
anni  tempestate,  qua  intermittentes  grassan- 
tur;  quibus  fere  semper  praeeuntibus,  tumor 
parvus,  et  vix  induratus,  in  Hypochondrio 
sinistro  exoritur.  Paulatim  crescit,  et  tandem 
haud  raro  molem  ingentem  adipiscitur.  Inci- 
piens  adhuc  et  parvus,  plerumque  parum  mo- 
lestias  facessit  ;  aliquando  vix  percipitur ;  ingra- 
vescente  vero  morbo,  sensationes  injucundae 
haud  paucae  aegroto  occurrunt. 

Idem,  diu,  nonnullis  in  casibus,  sine  dolore, 
manet.  Tumore,  autem,  magnitudinem  molcs- 
tam  adepto,  viscera  vicina  magnopere  compri- 
muntur  {d) ;  respiratio,  exercitatione  potissimum 
incitata,  redditur  anhelosa ;  et  si  sanguinis  circu- 
itus  valde  incitetur,  dolor  sed  raro  vehemens  diu- 
turnusve,  aegrotum  invadit.  Cum  vero  morbus 
inveteraverit,  sensus  gravitatis  et  tensionis,  max- 
ime  injucundus,  eum  saepe  inquietat.  Febris  le- 
vicula,  sospe  sub  vespere  accedens,  aliis  sympto- 
matibus  haud  raro  adjungitur.  iEger  febribus 
intermittentibus  obnoxior  fit,  quse  deinde  solito 

(d)  Casum  nuperrime  vidi,  ubi  Physcoiiia  Splenica  magni- 
tudinem ingentem  adepta  est,  viscera  vicina  compressit, 
usque  ad  Herniam  scrotalem  inducendam. 


>> 


16  Dissertatio  Inauguralis. 

vehemcntiores  et  pertinaciores  evadunt,  tumorem 
adaugent,  et  secundae  valetudinis  fundamenta  ex 
toto  labefactant.  Debilitas  quoque,  languor,  las- 
situdo,  torpor,  vultusque  pallidus  et  plumbeus, 
fere  semper,  sed  variis  gradibus,  hunc  morbum 
comitantur. 

Hie  tumor,  quibusdam  in  casibus,  molem  mi- 
rabilem  adipiscitur(<?).  Illust.  Van  Swieten  duo 
exempla  memorat,  ubi  Splen  paulatim  adauctus 
est  usque  ad  magnam  abdominis  partem  implen- 
dam,  et  in  pelvem  etiam  prolabendum(y).  Et 
M.  de  la  Motte  casum  recensethujus  mali,  adeo 
tandem  ingravesoentis,  ut  spatium,  hypochondri- 
um  sinistrum  inter  et  axillam,  fere  totum  occu- 
paret(^). 

Symptomata  Dyspeptica,  eaque  haud  raro  gra- 

(e)  Theoph.  Bond,  rapporte  d'apres  Hypol.  Boscus,  l'ou- 
verture  d'une  femme  attaquee  d'un  squirre  a.  la  rate,  qui 
s'etoit  tellement  accru  qu'il  remplissoit  l'abdomen,  et  pesoit 
trente  trois  livres.  La  malade  avoit  porte  cette  maladie  pen- 
dant dix-sept  ans,  vaquant  d'ailleurs  a  ses  occupations.  Nos 
hisloires  sont  remplies  de  pareils  exemples  touchant  lesquels 
je  renvoye  pour  abreger,  a  la  lecture  de  Schenkius,  du  Se- 
pidchretum  de  Bond,  et  de  la  Medecine  Stptentrionale,  No- 
sologic de  Sauvages  Tom.  11.  P.  295. 

{f)  Comment,  in  Boerh.  Aphorism.  Vol.  9.  P.  325. 

{g)  Traite  completde  Clururgie,  Tom.  11.  P.  169,  170.— 


Dissertatio  Inanguralis.  17 

vissima,  et  generis  etiam  pertinacioris,  regrum  fre- 
quenter vexant.  Hypochondriasis,  quoque,  saepe 
oritur  a  tumoribus  in  liene  aut  hepate,  qui  inter- 
dum  post  febres  intermittentes,  male  curatas,  ob- 
servantur.  Hujusmodi  tumores  liberum  sangui 
nis  motum  in  abdomine  plane  impediunt, 
ideoque  congestionem  producunt(/^). 

Exempla  non  desunt,  ubi  Physconia  Splenica 
Hydropem,  varii  generis,  induxisse  videtur  {%) ; 
rem  vero  frequenter  sic  se  habere,  vix  dicere 
ausim. 

Sunt  qui  credunt  hoc  malum,  paucis  in  ca- 
sibus,  in  schirrum  immedicabilem  transire,  qui 
tandem,  sed  raro  in  carcinoma  (£)  desinit,  non- 
nunquam  subito  lethale,  erosis  scilicet  magnis 
vasis  sanguinem  vehentibus,  plerumque  vero  len- 
tam  et  miserandam  tabem,  cum  febre  hectica  cer- 
tissime  exitiali,  i  nducturum  (/). 

Hoc   malum,   quamvis  fasdum  et  molestum, 

(h)  Gregor.  Dissertat.  Inaug.  De  Morb.  Caeli.  Mutat.  Me- 
dend.  P.  128. 

(i)  Illustr.  Pringle's  Diseases  of  the  Army. 

(k)  Drelincourt.  Dissert.  Anat.  Pract.  de  Lienoais  capt. 
xiv.  Opusc.  Omn.  P.  763. 

(/)  Conspect.  Med.  Theoret.  Vol.  1.  P.  401. 
C 


18  Dissertatio  Inaugurates. 

aliis  morbis,  gravioribusque  incomitatum,  mor- 
tem aegroto  haud  saepe  affert.  Et  systema  for- 
san  nullum  morbum  tarn  diu,  muneribus  vitae 
usitatioribus  tarn  parum  turbatis,  aliquando  etiam 
iisque  ad  senectutem,  tolerare  potest. 

DIAGNOSIS. 

Nullum  morbum,  praeter  Physconias  alias, 
novi,  cum  quo  hie  potest  confundi.  Et  si  locum, 
unde  tumor  exortus  est,  attente  observaverimus, 
non  est  in  his  cur  dubitemus. 

Graviditatem,  quoque,  quibusdam  in  exem- 
plis,  hunc  morbum  haud  parum  referre,  nonnulli 
credunt.  Intumescentia  vero  abdominis  gravi- 
das, ab  hypogastric  incipit,  opus  generationis  sub- 
sequitur,  et  partu  terminatur.  Cervix  uteri  cur- 
tatur;  foetus  vivus  inter  quartum  et  quintum 
mensem  sentitur  ;  et  dum  catamenia  supprimun- 
tur,  mammas,  usque  ad  lactis  eruptionem,  tumes- 
cere  solent. 

CAUSAE  REMOTE. 

H^e  vero  in  duplex  genus  distingui  solent. 
Adprimum  genus  pertinent  causae,  quotquot  cor- 
pus morbo  opportunum  reddunt ;  scilicet  ut,  ad- 
mota  causa  excitante,  morbum  suscipiat.  Ad 
alterum  genus  pertinent  quag  vocantur  potentia? 


Dissertatio  lnauguralis.  19 

nocentes,  vel  causae  excitantes ;  res,  scilicet, 
quaecunque  in  corpore  jam  proclivi  facto  morbum 
excitare  possint(/). 

Inter  ea,  quae  proclivitatem  tantum  ad  hunc 
morbum  faciunt,  recenseri  debent  aetas  puerilis, 
constitutio  corporis  debilis,  laxa  et  delicata,  vita 
otiosa  et  sedentaria,  sexus  sequior,  regio  paludo- 
sa,  victus  tenuis  et  parcus  ;  omnia  denique,  quae 
corpus  debilitant,  et  causis  excitantibus  affici  ob- 
noxium  reddunt. 

Hujus  mali  causae  excitantes  praecipuae,  for- 
tasse  solas,  sunt  febres  intermittentes  et  remitten- 
tes,  varii  generis,  et  atmosphaera  exhalationibus 
palustribus  inquinata.  Auctores  praeclaros  et 
omni  laude  dignos,  hanc  observationem  silentio 
praeterivisse,  aut,  hac  de  re,  aliter  omnino  sen- 
sisse,  ex  casibus  sequentibus,  multisque  aliis, 
qui  hie  recenseri  possent,  constare  videtur. 

Un  enfant  age  de  neuf  ans,  qui  avoit  ete  deliv- 
re  d'une  ascite  par  les  remedes  purgatifs,  fut  de- 
puis,  atteint  de  tres  vives  douleurs  dans  le  bas- 
ventre  ;  enfin,  il  seleva  dans  l'hypochondre  gauche, 
une  tumeur  considerable  et  douloureuse  sensible 
a  l'oeil,  et  aii  toucher.  A  l'ouverture  du  cadavre 
on  apper$ut,  outre  plusieurs  autres  choses,  que  la 

(I)  Greg.  Conspect.  Med.  Theoret.  Vol.  l.P.  23. 


20  Dissertatio  Inauguralis. 

rate  etoit  d'un  volume  extraordinaire  et  avoit 
change  de  figure  ;  qu'elle  s'elevoit  sur  Pestomach 
et  comprimoit  le  foie  ;  que  sa  couleur  et  sa  con- 
sistance  etoient  semblables  a  celles  du  foie  ;  il  n'y 
avoit  ni  squirre,  ni  ulcere,  ni  inflammation  ;  mais 
elle  etoit  obstruee  et  engorgee  par  le  sang,  qui  y  a- 
bordoit  en  plusgrandequantite  qu'il  n'en  sortoit.(£) 

Dans  un  enfant  mal  gouverne  par  sa  nourrice, 
qui,  au  lieu  de  lait,  lui  faisoit  manger  des  choses 
indigestes  pour  son  age,  il  se  forma  une  grande 
quantite  d'un  sue  lent  et  visqueux,  qui  remplissoit 
tellement  la  capacite  etroitedesvaisseaux  de  la  rate, 
que  ce  viscere,  qui  etoit  prodigieusement  gonfle> 
distendoit  tout  l'abdomen,  et  causoit  une  mai- 
greur  universelle  ;  Pobstruction  ayant  ete  levee  et 
la  surabondance  des  sues  diminuee,  la  rate  se  de- 
senfla  si  manifestement,  qu'il  parut  plus  clair  que 
le  jour,  que  cette  tumeur  n'etoit  pas  tant  occasi- 
onnee  par  la  mauvaise  conformation,  que  par  la 
surabondance  des  alimens.(/) 

Physconia Splenica,  his  in  exemplis,  ex  febribus 
intermittentibus  provenisse,  haud  equidem  dici- 
tur  ;  febres  vero  istiusmodi  praeivisse,  aut  malum 
in  regione  paludosa,  his  simul  grassantibus,  vel 
autumno,  atmosphrera  exhalationibus  palustribus 
inquinata,    ortum  esse,   minime   abnegatur.     Et 

(k)  (I)  Nosologie  tie  Sauvages,  Tom.  3.  P.  295. 


Dissertatio  Inauguralis.  21 

quicunque  secum  reputaverit,  quoties  hoc  malum 
ab  intermittentibus  manifeste  origintm  ducit,  et 
quam  raro  ab  aliis  causis,  ei  satis  patebunt  ratio- 
nes,  qua?  nos  in  hanc  sententiam  cogunt.  Tamen 
fateri  oportet,  multum  adhuc  requiri,  ut  hasc  opin- 
io pro  certa  et  stabilita  doctrina  recipiatur.  Vera 
et  certa  forsan  haud  mihi  contigit  novisse  ;  at  veri- 
tatem  summo  studio  indagavi ;  et  vero  similia,  ut 
speratur,  assecutus  sum.  "  Sequimur,  enim, 
probabiliora ;  nee  ultra  quod  verisimile  occurrit 
progredi  possumus,  et  refellere  sine  pertinacia,  et 
refelli  sine  iracundia,  parati  sumus."(m) 

CAUSA  PROXIMAL 

Cum  sit  plenissima,  et  perfectissima  proxima 
causa,  quippe  qua?  presens  morbum  facit,  subiata 
tollit,  mutata  mutat ;  summa  diligentia  conandum 
est,  ut  haec  res  clare  elucescat. 

Priusquam  vero  ad  causam  proximam  traden- 
dam  progrediamur,  pauca  sunt  praemittenda  de 
splenis  fabricatione,  de  variis  et  miris  modis,  qui- 
bus  natura  provida  operam  dedit  ad  motum  san- 
guinis per  hoc  viscus  retardandum,  et  de  procli- 
vitate  ad  hoc  malum  necessaria,  qua?  exinde  na- 
scitur. 

(m)  Cic.  Disput.  Tusculan.  Lib.  2. 


22  Dissertatio  Inauguralis. 

Splenis  fabricam  sive  texturam,  laxam,  tene- 
ram  et  permollem(rc)  esse  ;  et  ei  majorem  sangui- 
nis copiam,  quam  aliis  visceribus,  pro  rata  parte, 
deferri/o)  a  Physiologis  omnibus,  hodie  concedi- 
tur.  Quam  proclivis  sit,  ad  turgendum,  ab  intu- 
mescentia  ejus,  vacuo  ventriculo,  naturaliter  et 
constanter  oriunda,  quap  tamen,  post  pastum,  in 
minorem  moiem  statirn  redigitur,  colligere  li- 
cet.^) 

Arteria  Splenica,  ab  Caeliaca  oriens,  multo  am- 
pliorf^j  est,  pro  ratione  et  molis  et  ponderis  hujus- 
ce  visceris,  quam  in  aliis  partibus  observatur ; 
tunicis  etiam  iis  aortas  crassioribus  instruitur;fr) 
et  sanguinis  per  earn  motus,  propter  cursum  ejus 
serpentina  m,  et  parietum  duritiem  raram,  lentis- 
simus  evadit.(^)  Vena  Splenica,^)  et  tela  quo- 
que  ejus  cellulosa,(«)  fabrioam,  multo  quam  in 
aliis  visceribus  molliorem  et  ad  distentionem  ap- 
tiorem,  ostendit. 

Difficilis  sanguinis  transitus  ad  Hepar  per  ve- 

(n)  Haller.  Prim.  Lin.  Physiol.  Vol.  2.  P.  99.— Hewson. 
apud  Duncani  Comment.  Vol.  1.  P.  100. 

(o)  Haller.  ibid.  (p)  Ibid. 

(q)  Haller.  Prim.  Lin.  Physiol.  Vol.  2.  P.  99. 

(r)  Ibid,     (s)  Ibid.      (/)Ibid.      (u)  Ibid.  101. 


Dissertatio  Inauguralis.  23 

nam  portde\  at,  pra?  omnibus,  lentior  ejus  motus, 
persplenem  ipsum,  proter  auctam  vasoru  u,  prout 
in  rainos  dividuntur,  capacitatem,  quod  hoc  in  vis- 
cere  insigniter  obtinet  ;(w)  his  omnibus  attente 
consideratis,  causae  retardationis  potentissimap 
apparebunt. 

Sanguis,  in  vena  splenica,  liquidissimns  reper- 
itur  ;(x)  et  fere  nullam  ad  coeundum  proclivita- 
tem  ostendit. 

Ha?c,  quicunque  rite  consideraverit,  is  bene 
perspiciet,  labore  quam  strenuo  natura  conata  est 
motum  sanguinis  per  hoc  viscus  retardare  ;  et  si- 
mul  illi  persuasum  erit  talem  retardationem  max- 
ime  necessariam  esse,  ad  consilia  gravissima  in 
oeconomia  humana  perficienda. 

Ratio  fluiditatis,  quas  tarn  insigniter  in  san- 
guine splenico  obtinet,  a  motu  ejus  tardissimo 
petenda  est.  Haec  remora  eum  longius  a  pul- 
mone  cohibens,  istam  ad  coeundum  proclivitatem, 
qua3  ab  circuitu  per  pulmonem  provenit,  minuere 
videtur. 

"  Aeris  ad  sanguinem  extra  vasa  aditum,  ejus 
coagulationem  promovere,  neutiquam  dubitan- 
dum  est ;  cujus  rei  nullam  explicationem  eo  ten- 

(w)  Ibid,     (x)  Ibid.  102. 


24  Dissertatio  Inauguralis. 

tabo,  quod  ad  propositnm  nostrum  veram  earn  et 
observatam  esse,  suffi  it.  Tenuem  quoque  pul- 
monnm  membranam  non  sufficere  ad  mutuam 
aeris  ethumon>m  inter  se  actionem  prohibendam, 
constat  ;(y)  unde  sang»inem,  qui  pulmonalem  iir- 
culum  transfluxit  ad  coeundum,  coeteris  paribus, 
sanguine,  qui  illic  mutationem  non  subiit,  promp- 
tiorem  esse,  'olligimus  ;  ergo  sanguinem,  omni 
in  exemplo,  ubi,  pro  brevi  etiam  temporis  spatio, 
beneficiis  ab  'ire  -itu  per  pulmonem  oriundis, 
privatur,  fluidum  dissolutumque  esse,  necesse  fo- 
ret ;  quae  onclusio  innumeris  observationibus 
nititur;(z)  ita  sanguis  venosus,  quam  arteriosus, 
licet  hie  majori  motui  quam  ille  objicitur,  minus 
tamen  ad  coeundum  proclivis  est. (a)  Incisis  stib- 
mersorum  corporibus,  liquiditas  in  sanguine  insig- 
nis  reperitur  ;  venae  portae  sanguis,  etiam  minus 
quam  venosus,  ad  coeundum  promptusest;(6)  san- 

(y)  Vide  Halesii  Haemastat.  Priestley's  Observations  on 
Air,  &.c.  &.c. 

(z)  Vide  Lond.  Med.  Transact.  Vol.  3.  P.  9.  Dr.  Lam 
grish'sPhys.  Exper.  on  Brutes,  P.  66.  145.  Vide  Greg.  Hor- 
stii  junioris  op.  torn.  1.  P.  136.  142.  In  homine  fumo  carbo- 
num  necato,  sanguis  fuit  solutus.  Sagar  555.  Morgagni  de 
caus.  et  sed.  niorb.  Lib.  ii.  Exp.  xv.  P.  131.  &.c. —  Bonet. 
Sepulchret.  Anat.  Lib.  ii.  Sect.  i.  obs.  xviii.  &,c. 

(a)  Dr.  Stevenson  Med.  Ess.  Edin.  Vol.  5.  part  ii.  332. 

(b)  Praelect.  Celeberrim.  Prof.  Monro. 


Dissertatio  lnauguratis.  25 

guis  in  embryone  quam  in  matre  fluidior  est.(6") 
Somniculosorum  animalium  sanguis  per  totam  hy- 
emem  tenuis  dissolutusque  permanet,(c?)  quia  cir- 
cumfluxio  quaedam  sine  respiratione  aliquamdiu 
conservatur."(e) 

His  rebus  pra?fatis,  ad  causam  hujus  morbi 
proximam  reddendam,  tandem  progi'edimur. 
Earn,  vero,  ex  humoribus  congestis,  et  languido 
et  impedito  eorum  per  splenem  motu,  constare, 
omnibus  satis  innotuit. 

Retardationibus,  quas  natura  sanguinis  motui 
hie  imposuit,  probe  consideratis,  hoc  malum,  nos- 
tris  in  regionibus  palustribus,  frequentissime  oc- 
currere,  nil  est  cur  miremur. 

Causa  proxima  sic  posita,  ad  modum  indagan- 
dum,  quo  haec  congestio,  et  motus  sanguinis  lan- 
guidus  provenire  possint,  nunc  progredimur. 
Congestio,  ex  humoribus  in  vasa  splenica  accu- 
mulatis  et  impactis  (e,)  vel  ex  iis  in  telam  reticu- 

(c)  Martini  Lister.  Dissertatio  de  Humoribus,  cap.  i.  14. 

(d)  Lister — Maclurg's  Treatise  on  the  Bile.     Hewson,  &c. 

(e)  Dissertat.  Inaug.  M'Donnel.  1784. 

(e)  Dilatatio,  Evg vtftu,  cum  parietes  cavitatis,  nimium  inter 
se  distantes  spatium  justo  capacius  circumscribunt.  Obti- 
nere  potest  in  quibuscunque  cavis  corporis,  majoribus,  minor- 


26  Dissertatio  Inauguralis. 

latam  vicinam  effusis  (/*),  plerumque  Oritur. 
Utramque  causam,  multis  saltern  in  casibus,  con- 
jungi,  satis  verisimile  videtur. 

Exemplis  in  levibus  et  incipientibus,  fluido- 
rum  coaccrvatio  et  impactio  sola  fortasse  in  vi- 
tio  sint.  Cum  vero  malum  inveteraverit,  et  mo- 
lem  enormem  sit  adeptum,  effusionem,  et  quidem 
copiosissimam,  accedere,  minime  in  dubio  esse 
videtur.  Argumentis  quae  subsequuntur,  in 
banc  sententiam  ducor. 

lmo.  Moles  magna,  et  pene  incredibilis,  quam 
hie  tumor  nonnunquam  adipiscitur,  nos  vetat, 
earn  tribuere  ulli  vasorum  distentioni,  quam,  pa- 
rietes,  salva  integritate  et  circulatione  vitali,  ad- 
mittere  possunt. 

ibus  quorum  parietes  distentionem  admitlunt.  Oritur  au- 
tem,  si  contenta  materies  majore  vi  in  lalera  agit  distendendo, 
quam  haec  superare  contra  nitendo  queant.  Quo  facit  congesta 
uberior  moles,  volumen  expansione  auctius,  impedftus  tra- 
jectus,  impetus  advectorum  enormis  ;  parietum  robur  immi- 
nutum,  aut  eorum,  quibus  a  foris  fulciuntur,  ablatio. 

Gaub.  Instit.  Patholog.  Med.  P.  85. 

(f)  Avctrot4.am,  quae  hie  vocatur  ostii  cavitatis,  quod  admit- 
tit  aut  emittit,  immodica  laxatio.  Unde  fit,  ut  plus  autaliud 
quid,  quam  lex  sanitatis  exigit,  introeat,  exeatve.  EflRcere 
hanc  eadern  possunt,  quae  dilatationem. 

Gaub.  Instit.  Pathol.  Med.  P.  85. 


Dissertatio  Inaugnralis.  27 

2do.  Subita  diminutio  et  sanatio,  qualem  hoc 
malum  aliquando  suscipiat,  nisi  effusio  pro  vero 
admittatur,  explicationem  accipere  non  po- 
test (g). 

3tio.  Vasorum  lymphaticorum  in  telam  Sple- 
nis  reticulatam  hiantium,  frequentia  insignis ;  et 
sanguinis  rubri  ipsius  deprehensio  in  vasis  istis 
lymphaticis,  eum  per  has  vias  transire  posse,  clare 
demonstrat  (A). 

4to.  Ex  analogia  quam  praebet  Phlogosis.  Ef- 
fusio, hie,  Culleno  illustrissimo  teste,  magnam 
morbi  partem  facit.  "  The  tumour,  (inquit  ille) 
which  appears  in  inflammation,  may  be  imputed, 
in  part,  to  the  congestion  of  fluids  in  their  pro- 
per vessels ;  but  is  owing  chiefly  to  an  effusion 

(g)  Vir  excellentissimus,  Dr.  Clayton,  qui  Reipublicse  De- 
lavarensi,  summa  cum  dignitate  et  virtute,  hodie  praesidet,  se- 
quentem  casum  milii  mittendum  per  literas,  nuper  curavit. 
A.  B.  Vir,  quadraginta  annos,  aut  circiter  natus,  Physconia 
Splenica,  magnam  abdominis  partem  occupante  e  febribusin- 
termittentibus,  pertinacioribus,  et  frequenter  redeuntibus,  pro- 
veniente,  viginti  annos,  vel  amplius  laboraverat.  Correptus 
Cholera  violentissima,  et  exinanitionibus  copiosissimis,  plu- 
res  dies  continuatis  debilitatus,  fere  ad  extremum  reductus 
est.  Convalescens,  tandem,  Physconiam  Splenicam  ex  toto 
evanuisse  attonitus  deprehendit.  Dehinc  tamen  a  morbo 
liber  vixit,  et  adhuc,  post  plures  annos,  vivit. 

(h)  Hewsoni  Epistola  ad  Dr.  Hay  garth,  apud  Duncani 
Comment.  Vol.  3,  P.  91. 


28  Dissertatio  Inauguralis. 

of  matter  into  the  adjoining  cellular  texture  ;  and, 
accordingly,  tumours  seldom  appear  but  in  parts 
adjoining  to  a  lax  cellular  texture  (i). 

5to.  Liquiditas  sanguinis  insignis,  quae  hoc  in 
viscere  observatur,  eum  facillimum  effusu  pro- 
culdubio  reddit. 

Quandocunque  malum  ex  humoribus  in  vasa 
propria  tantum  impactis,  nascitur,  sedem  conge- 
stionis  praecipuam  venae  praebent,  quippe  quae,  in 
hoc  viscere,  mollissimre,  et  ad  distentionem  ap- 
tissimae  sint.  In  his  quoque  vis  a  tergo  parva,  et 
contractio  musculorum  vicinorum  et  incumben- 
tium  parum  efficere  potest  (k). 

Quaedam  corporis  conditiones  morbosae,  par- 
tem causa?  proximae  haud  parvam  faciunt,  et  hoc 
malum  saepe  multo  frequentius  et  pertinacius  red- 
dunt.  Praeter  obstructionem,  quae  iter  humo- 
rum  splenicorum  impedit,  languescit  saepe  san- 
guinis universi  corporis  motus,  imprimis  ob  debi- 

(?)  First  Lines  of  the  Practice  of  Physic,  Vol.  I.  P.  229. 

(k)  Quicquid  causa  fuerit,  quod  sanguis  languidius  move- 
tur,  malum  in  venas  maxime  incumbit ;  nimirum,  quia  in 
his  sanguinis  motus  semper  tardiorest.  Hinc  varices  vena- 
rum,  et  congcstiones  sanguinis,  prffisertim  in  iis  partibus,  qua- 
rum  venae  valvis  carent,  et  in  quibus  motus  musculorum 
sanguinis  cursumjuvare  nequit.  Conspect.  Med.  Theore!. 
Vol.  LP.  252. 


Dissertatio  Inaiignralis.  29 

litatem,  torporem,  defectum  irritationis,  veluti  ex- 
ercitationis  ;  sicubi  vel  vires  deficiunt,  vel  non  ut 
decet,  excitantur,  aut  excitari  possunt  (/). 

PROGNOSIS. 

In  eventu  hujus  morbi  praesagiendo,  ad  aegro- 
tantis  aetatem  ;  ad  regionem  quam  incolit  ;  ad 
corporis  constitutionem,  sive  debilem  et  laxam, 
aut  robustam  ;  ad  morbi  tempus ;  et  denique,  ad 
vitae  genus  ;  medicum  semper  respicere  oportet. 
Si  vires  vitce,  senio,  et  morbis  praegressis  fractas 
et  exhausto3  sint,  praesagium  felix  vix  deduci 
potest.  Regio  paludcsa  malum  multo  pertina- 
cius  reddet,  et  depulsum  saepe  revocabit. —  Con- 
stitute corporis  laxa,  proclivitatem  ad  hunc  mor- 
bum  perpetuam,  et  sanationem  difficiliorem  facit. 
Quo  diutius  malum  permanserit,  eo  difficilius  est 
plerumquesanatu.  Vitae  genus  otiosum,  seden- 
tarium  et  deses,  fere  semper  ad  morbum  confir- 
mandum  augendumque,  magnopere  confert. 

iEtate  provectiore,  vis  nervosa  imminuitur; 
partes  corporis  solidae  indurescunt ;  et  hinc  vasa 
minutissima  coarctantur,  et  tandem  concludun- 
tur ;  et  motus,  et  distributio  fiuidorum  maxime 
inipediimtur.  Hasc  omnia  Physconiam  Spleni- 
cam  confirmant,  et   spem  sanationis,    magna  ex 

(l)  Conspect.  Med.  Theoret.  Vol.  1.  P.  251. 


30  Dissertatio  Inaugurahs. 

parte,  adimunt.  Sedjuveni  vegeto,  ad  exercita- 
tionem  prompto,  et  caetera  sano,  plerumque  pros- 
peram  sanationem  polliceri  licebit. 

RATIO  MEDENDI. 

Summis  viribus  eniti,  ad  cohortem  morborum, 
qui  insanabiles  habentur,  minuendam,  munus  est 
splendidissimum,  et  utilissimum,  quo  ars  nostra 
salutifera  fungi  possit.  De  asgroti  salute  despe- 
rare,  quia  mala  hujusmodi  plerumque  cedere  no- 
lint,  medico  sapiente,  et  qui  nihil  humanum  a  se 
alienum  putat,  minime  est  dignum.  Haec  ad 
oegros  derelinquendos  proclivitas,  maximam  Me- 
dicinse  injuriam  intulit,  artem  nostram  debilem  et 
ignavam  reddidit,  et  opprobrium  medicorum,  per 
omnia  saecula,  exstitit. 

Consilia,  autem,  medendi  sunt, 

I.  Causas  remotas  tollere. 

II.  Humorum  congestiones  expedire,  mo- 
tumque  eorum  languidum  atque  difficilem  ex- 
citare. 

III.  Corporis  totius  habitum  depravatum  cor- 
rigere,  tonum  viresque  idoneas  systemati  redderc. 

IV.  Morbum  recidivum  arcere. 

I.  Quantum  ad  primum  consilium  attinet,  ei  ac- 
commodantur  remedia  roborantia  omnia,  qualia  ad 


Dissertatio  Inauguralis.  31 

febres  intermittentes  et  remittentes  medendas, 
nusquam  non  exhibentur.  Inter  hgec,  Cortex 
Peruvianus  primum  sibi  locum  vindicat.  Vires 
hujus  remedii  praestantissimi,  tarn  late,  et  quidem 
universaliter  innotescunt,  ut  de  iis,  hoc  in  loco, 
disserere,  vix  sit  opus. 

Prohibuerunt  auctores  clarissimi,  et,  inter 
alios,  Cullenus  venerandus  ipse,  Corticem  Peru- 
vianum  adhibere,  ad  febres  intermittentes  meden- 
das, existente  simulcongestione  firma  in  visceribus 
abdominalibus  (m).  Haec  opinio,  ex  erroribus 
Pathologies  Humoralis,  proveniens,  quantum- 
cunque  apud  medicos  olim  recepta,  hodie  pene 
exolevit.  Et  medici  maximi  nominis,  Corticem 
Peruvianum  ad  febres  intermittentes  summoven- 
das,  nulla  fere  ad  Physconiam  Splenicam  ratione 
habita,  quotidie  adhibent  (n). 

II.  Secundo  consilio  accommodantur  Remedia 
Roborantia  et  Stimulantia,  fere  innumera ;  qua?, 

(m)  The  Bark  may  be  employed  with  safety  at  any  pe- 
riod of  Intermittent  Fevers,  providing  that  at  the  same  time, 
there  is  neither  a  phlogistic  diathesis  prevailing  in  the  system, 
nor  any  considerable  or  fixed  congestion  present  in  the  ab- 
dominal viscera. 

First  Lines,  Vol.  1.  P.  207. 

(w)  Dr.  D.  Monro's  Observat.  Illustr.  Pringle's  Diseases  of 
the  Army.  Dr.  Saunders  on  the  Bark. — Cleghorn's  Minor- 
ca.   Lind  on  Hot  Climates. 


32  Dissertatio  Inauguralis. 

inter  se,  turn  quod  ad  caeteras  et  magis  manifes- 
tas  dotes,  turn  maxime  q:-od  ad  vires  suas  medici- 
nales,  admodum  diversa  sunt.  Inter  hrec,  se- 
quentia,  in  nostrum  propositum,  seligenda  putavi. 

1.  Emetica.  2.  Cathartica.  3.  Mercurius. 
4.  Electricitas.  5.  Ferrum.  6.  Cortex  Peru- 
vianus.  7.  Vinum.  8.  Balneum  Frigidum.  9. 
Exercitatio.     10.  Frictio.     11.   Casli  mutatio. 

Emetica^  in  hujusmodi  malis  prodesse  videntur, 
partim  stimulo  sno,  ventriculo  admoto,  perque 
consensum  cum  aliis  partibus  communi*  ato,  par- 
tim vehemente  agitatione  et  inverso  motu  ventri- 
culi  et  superioris  partis  intestini,  partimdemum  in- 
gente  pressura,  quae,  inter  vomendum,  a  septo 
transverso  musculisqvie  abdominis  valide  con- 
tractis,  omnibus  quae  in  abdomine  continentur 
partibus  datur  (o). 

Vomitiones,  quoque,  motum  sanguinis,  in  ab- 
domine, saspe  languidum,  variis  modis  haud  pa- 
rum  expedient,  partesque  affectas  probe  exci- 
tant et  agitant.  Vomitiones  autem,  non  modo 
per  abdomen  sanguinis  motum  promovent, 
ej  usque  viscera  stimulant,  sed  totum  genus 
nervosum  quodammodo  excitant,  et  partim  hoc 
stimulo,  partim  magnis  nixibus  et  agitationibus 

(o)  Conspect.  Med.  Theoret.  Vol.  2.  P.  445. 


Dissertatio  Inaugaralis.  33 

quas  efficiunt,  pulsus  festinant,  motumque  san- 
guinis per  totum  corpus  accelerant,  et  fclmul 
asqualem  ejis  distributionem  efficiunt,  congesti- 
ones  aut  distributiones  abnormes  tollunt,  et  ac- 
tionem vasorum  absorbentium  intendunt. 

Exemplum  genu  ex  magna  synovia?  accumulate 
copia  tumefacti,  profert  accuratus  Cruikshank. 
Magna  quantitas  salis  tartari,  pro  solubili  tartaro 
errore  data,  vomitum  per  quadraginta  octo  usque 
horas  violentem  concitabat.  Vomitu  finito,  post- 
quam  asgri  stomachus,  ex  medicamento  inftamma- 
tus,  cito  sanus  fiebat,  tumor  genu  fere  omnino  dis- 
persus  reperiebatur  (p). 

iEgroto,  curae  Joannis  Hunter  commisso,  bubo 
erat,  adeo  provectus  ut  in  animo  esset,  die  se- 
quente,  eum  aperire.  iEger  interea  navem  as- 
cendit,  ubi  nausea  correptus,  abunde  admodum 
vornuit.  Bubone  penitus  evanescente,  auxilii 
chirurgici  nil  indiguit  (g). 

Cathartica.  Alvi  autem  purgatio,  plena  saltern 
et  valida  si  fuerit,  non  modo  res  omnes  quae  in  in- 
testinis  continentur,  expellit,  sed  per  stimulum 
medicamenti  iis  admoti  vis  nervosa?  derivationem 
abdomen  versus  efficit,  motumque  sanguinis  per 

(p)  Cruikshank's  Letter  to  Clare.  P.  166. 

(9)Disser.  Inaug.  Winterbottom.  1781- 

£ 


34  Dissertatw  Inauguralis. 

omnia  hujus  viscera  promovet,  et  actionem  vaso- 
rum  absorbentium  excitat  atque  intendit  (s). 

Mercurius.  Hoc  remedium  praestantissimum 
eo  modo  et  consilio  feliciter  adhibetur,  ut  vasa 
sanguifera  et  absorbentia  levi  vel  nullo  ptyalismo 
excitato,  stimulet  ;  sic,  enim  optime  cavetur,  ne 
aegrotantis  vires  consumantur.  In  hunc  finem 
Pilul.  Mercur.  Ph.  Edin.  eligenda?  videntur,  prae 
salibus  e  mercurio  paratis,  quippe  quae  per  alvum 
se  prascipitare  solent. 

Electricitas.  Quantum  subtilissima  haec  atquc 
mobiiissima  aura  polleat  ad  schirros  discutiendos, 
ad  promovendam  rerum  variorum  absorptionem, 
etiamquc  ad  callos  ossiuni  iuxuriantes  amovendos, 
fere  omnibus  notum.  Animalium  corpora  non 
modo  velocissime  pervadit,  sed  simul  validissimo 
stimulat,  sensumque  in  partibus  sentientibus,  mo- 
tumque  in  partibus  musculosis,  mirabiliter  exci- 
tat. In  cursu  sanguinis  languido  per  vasa  minu- 
tissima  expediendo,  vires  mirandas  ostendit.  Cel. 
Ai)bas  Nollet,  qui  ingeniose  admodum  plurima 
in  electricitatis  doctrina  investiganda,  expenmen- 
ta  fecit,  aquam  guttatim  e  tubo  insulato  deciden- 
tem,  electricitate  adeo  accelerari,  ut  plena  flueret 
cursu,  perspexerit  (t).     Hoc  experiment um  ad 

(s)  Conppec.  Med.  Theoret.  Vol.  2,  P.  464. 

(I)  Mem.de  L'Academ.  Royale  pour  1758,  Vol.  2,  P.  241. 


Dissertatio  Inauguralis.  35 

vegetabilia  et  animalia  transtulit,  quorum  perspi- 
rationem  auctam  invcnit  (u). 

Observandum,  quoque,  est,  hoc  remedium,  ut- 
cunque  validum,  parum  ssepe  prodesse,  nisi  large 
adhibitum  fuerit,  diuque  continuatum  (v). 

Ferrum.  Hoc  inter  praestantissima  et  tutissi- 
ma  eorum  remedioru  ,  quae  vi  gaudent  tonica, 
merito  recensetur.  Medicamentum  ubique  fere 
paratum,  vix  longiori  usu  nociturum,  tantulaque 
portione  ad  infirmatum  hominem  reficiendum  effi- 
cax,  haud  mediocrem  opem  regrotantibus  promit- 
tit.  Devorari  potest,  vel  in  particulas  minutas 
limando  tritum,  vel  ad  formam  rubiginis  per  hu- 
morem  et  trituram  redactum. 

Cortex  Peruvianus.  Nobilissimi  hujus  reme- 
dii  usus  beneficia  maxima  in  genus  humanum 
contulit.  Ex  quo  genuinus  ejus  effectus  in  corpus 
humanum  innotuit,  vix  ullus  quidem,  debilis  lax- 
seque  fibrae  soboles,  se  prodit  morbus,  quin  ad 
eum  illico  decurratur.  Sed  ex  repugnantia  mira, 
et  quidem  perniciosa,  quam  medi  i  tarn  diu  et 
pertinaciter  ostenderunt,  ne  Corticem  Peruv.  ex- 
perirentur,  adPhysconiam,  Splenicam  medendam, 
malum  id,  omnino  mite  et  fugax,    cum  sit  rite 

(w)  Ibid.  248. 

( v)  Greg.  Conspect.  Med.  Theoret.  Vol.  2,  P.  303. 


^6  Dissertatio  Inauguralis. 

tractatum,  in  morbum  immedicabilem  haud  raro 
mutavit(w). 

Vinum.  Omne  genus  vini,  et  magis  adhuc  me- 
raciorcs  iHi  latices,  Spiritus  distillati  dicti,  corpori 
stimulosuntcertissimo,  et  gratissimo,  et  saepe  salu- 
berrimo.  Et  istiusmodi  jam  remedia  (ubicunque 
si  i,  uio  interno  et  generali  opus  est)amedicis  mul- 
to  largius  p  aescribuntur  quam  olim  fieri  solebant, 
et  quidem  cum  insigni  aegrotantium  commodo.* 

Balneum  Frigidum.  Usus  balnei  frigidi,  pro 
remedio  roborante,  tarn  saspe  prass  ribitur,  ejus- 
que  saluberrimi  effectus  in  plurimis  morbis  tarn 

"  (n?)  This  tumour  (Physconia  Splenica)  when  large  and  ob- 
stinate, is,  he  thinks,  by  no  means  free  from  danger.  When 
it  admits  of  cure,  this,  he  thinks,  is  to  be  effected  by  the  Peru- 
vian Bark  ;  because  its  origin  and  increase  depend  on  the  in- 
termittent fever.  And  while  neither  internal  aperients,  nor 
ointments  applied  externally,  are  of  any  avail,  by  the  use  of 
the  Bark  it  will,  he  affirms,  be  completely  resolved,  if  it  be 
not  of  long  standing.  And  he  even  alleges,  that  by  long 
continuance  of  the  Bark,  he  has  known  very  large  tumours 
of  the  spleen  totally  discussed." 

Cel.  Strack.  Observ.  Med.  de  Feb-. 

Intermitt.  apud  Duncani  Comment. 

Decad.  2,  Vol.  2,  P.  131. 


*  Observationibus  accuratissimis  constat,  timulentos  raris- 
sime  hoc  malo  laborare- 


Dissertatio  Inauguralis.  37 

bene  jam  sunt  noti,  ut  nemo  medicorum  de  iis  du- 
bitare  possit. 

Exercitatio.  Idonea  corporis  exercitatio,  pro 
remedio  roborante,  omni  laude  major  est.  De 
modis  variis,  quibus  prosit,  utpote  omnibus  satis 
notis,  non  hie  est  locus  dicendi.  Pro  aegroti  vir- 
ibus  atque  consuetudine,  mitiora  vel  violentiora 
exercitationis  genera  praescribenda  sunt. 

Labor  improbus  et  assiduus,  inter  remedia  hu- 
jus  mali  efficacissima,  primum  fortasse  sibi  lo- 
cum vindicat.  Hinc  occupationes  qusedam,  acti- 
onem musculorum  validam  et  fere  perpetuam 
postulantes  homines  iis  deditos,  et  inde  victum 
quserentes,  a  morbis  hujusmodi,  immunes  prse- 
stare,  plerumque  observantur.(y)  Et  experientia 
satis  constat,  hoc  malum  iis  prascipue  incumbere, 
qui  vitam  ignavam  et  sedentariam  degunt. 

Si  aeger  hujusmodi  labores,  et  corporis  exerci- 
tationes  vehementiores,  veluti  ambulationem,  gla- 
diatoriam,  cursum,  saltationem,  et,  similia,  tole- 
rare  nequit ;  tunc  tentanda  sunt  mitiora  exeroita- 

(y)  La  Nature  est  juste  envers  les  Homines :  elle  les  re- 
compense de  leurs  peines ;  elle  les  rend  laborieux,  parce 
qu'a  de  plus  grands  travaux  elle  attache  de  plus  grandes  re- 
compenses. 

L'Esprit  des  Lois,  Tome  2,  P.  4. 


38  Dissertatio  Inaugurate. 

tionum  genera,  quee  scilicet  gestationes  vocantur. 
Inter  gestationes,  equitatio,  caeteris  omnibus  longe 
praestat ;  actio  enim  musculorum  hand  exigua  in 
ea  requiritur,  sed  adeo  levis,  et  ita  variata,  ut  eti- 
am  valde  infirmis,  iisque  qui  plane  ambulare  non 
possent,  tolerabilis,  et  grata,  et  valde  salutaris  fiat. 
Longa  itinera,  in  regiones  salubres  equitatione  per- 
acta,  in  hoc  malo  magnopere  prosunt.  iEgro, 
vero,  neque  ad  hanc  optimam  gestationem  valenti, 
mitiora  praescribenda  sunt  gestationis  genera,  et 
maxime  gestatio  in  rheda,  et  navigatio,  quae  reve- 
ra  saepe  quam  optime  profuerunt. 

Frictio.  De  hujus  utilitate,  in  Physconia  Sple- 
nica traitanda,nanimeambigitnr.  Viribusmuscu- 
lorum  opitulari  videtur,  et  certe  sanguinis  cursum 
ji^vat,  et  actionem  vasorum  resorbentium  multum 
promovet.  Fri  tionem  in  tumorem  ipsum  dirige- 
re,  et  earn  validissime  adhibere,  semper  oportet. 
Usvis  Unguenti  e  mercurio,  ad  partem  inter  fricti- 
onem  defendendam,  et  simul  ad  corpus  univer- 
sum  hoc  remedio  imbuendum,  mininie  a  consilio 
medendi  alienus  foret. 

Calx  Mutatio.  Ex  observationibus  innumeris 
satis  patet  dispositionem  ad  multos  morbos  ex 
statu  caeli  et  aeris  provenire.  Ratio  ergo  suadet, 
multos  morbos,  ex  caeli  intemperie  ortos,ca2li  mu- 
tatione  praecaveri  et  sanari  debere.  Nee  aliter 
res  se  habet.  Plurimi  enimmorbi,nullis  aliis  reme- 


Dissertatio  Inaiiguralis.  39 

diis  domandi,  tempestate  vel  ccelo  mutato  sponte 
evanescurit,  aut  levantur.  Et  omnes  medici,  tarn 
veteres  quam  recentiores,  in  hoc  consentiunt, 
caeli  mutationem  multum  esse  auxilii  in  variis 
morbis,  vix  aliter  medendis. 

III.  Ad  tertium  nostrum  medendi  consilium  re- 
spondendum, multa  qua?  sub  sec undo  consilio 
comprehensa  sunt,  in  usum  revocanda.  Idoneus 
cibus,  vina  generosa,  exercitatio  assidua,  cortex 
pernv.  costeraque  amara,  ferrum,  balneum  frigi- 
dum,  et  cash  mutatio,  atque  omnia  denique  qua? 
corporis  tonum  augent,  neque  ventriculo  sunt 
aliena. 

IV.  Ad  quartum,  ultimumque  consilium,  jam 
ventum  est,  morbum  recidivum  nempe  arcere. 

Hoc  optime  prasstabit  eorumdem  remediorum 
continuatio,  qua?  sub  tertio  consilio  recensimus  ; 
et  praecipue,  cibus  idoneus,  vina  generosa,  exer- 
citatio crebra,  balneum  frigidum,  atque  in  regio- 
nem  patria  salubriorem,  migratio. 


Nihil  amplius  mihi  restat,  Dissertatiunculae  huic 
jam  finem  imposituro,  quam  ut  alma?  huic  Aca- 
demic, unde  tot  et  tanta  benencia  accepi,  optima 


30  Dissertatio  Inauguralis. 

voveam.     Diu  floreat,  scientias  decus,  patriaeque, 
rebus  in  adversis,  presidium. 

Denique,  liceat  mihi,  Professoribus  hujusce 
Academics  illustribus,  meritas  agere  gratias.  Ob 
insignem,  in  arte  propria,  peritiam,  et  in  omni 
literarum  genere  scientiam  ;  ob  benevolentiam  et 
urbanitatem,  inMedicina?  studiososdemonstratam, 
quantas  sibi  laudes  collegerint,  nemo  est.  qui 
non  audivit.  Quantam  deleetationem  a  praelecti- 
onibus  eorum  eruditis  quantumque  fructum,  ipse 
perceperim,  semper  meminisse  juvabit.  Scienti- 
am Medicam  ornare  atque  excolere  diu  pergant ; 
sint  norentes,  sint  honoratissimi,  sint  beati. 


CURSORY    OBSERVATIONS 


OKT    THAT 


FORM    OF    PESTILENCE 


CALLED 


YELLOW  FEVER. 


TO 

SAMUEL  L.  MITCHILL,  M.  D.  F.  R.  S.  E. 

PROFESSOR    OF    NATURAL    HISTORY    IN    THE 
UNIVERSITY   OF   NEW-YORK,  &C. 

My  dear  Sir, 

I  hope  you  will  pardon  the  liberty  I  take  in 
prefixing  Your  name  to  the  following  Memoir. 
To  whom  can  it  be  so  properly  inscribed  as  to 
the  affectionate  and  uniform  Friend,  the  literary 
Associate  and  Fellow-labourer,  and  the  Colleague 
in  academical  office,  of  its  lamented  Author  ? 

Seldom  has  a  literary  connection  been  more 
uninterrupted  and  happy,  than  that  which  sub- 
sisted between  You  and  my  Brother,  for  near  six- 
teen years.  Knowing,  as  I  do,  the  history  and 
character  of  that  connection,  You  will  not  wonder 
that  I  feel,  in  approaching  You,  as  if  I  were  ad- 
dressing a  surviving  Relative  ;  and  as  if  you  had 
a  higher  interest,  than  that  of  mere  compliment, 
in  all  the  productions  of  his  mind. 

With  fervent  wishes  for  the  long  continuance 
of  your  honours  and  usefulness,  and  for  the  pro- 
motion of  your  best  welfare,  I  am,  dear  Sir, 

Most  respectfully  and  affectionately, 
Your  friend, 

THE  EDITOR. 

Nov- York,  August  9th,  1313. 


CURSORY  OBSERVATIONS,  8fc. 


JL  HE  design  of  the  following  paper,  as  it  is  sim- 
ple and  definite,  may  be  comprised  in  a  few  words. 
It  is  intended  to  combine  a  number  of  facts  re- 
lating to  the  operation  of  Poisons  on  the  animal 
system;  to  compare  them  with  the  action  of  febrile 
miasmata ;  and  to  draw  such  conclusions  concern- 
ing the  nature,  prevention,  and  treatment  of  pes- 
tilential diseases,  as  may  appear  legitimately  to  re- 
sult from  the  comparison. 

The  mode  of  illustrating  the  nature  of  fever,  by 
considering  its  remote  cause  as  a  poison,  leads  to 
an  interesting  train  of  inquiry,  and  furnishes  a 
great  number  of  instructive  and  luminous  analo- 
gies.    It  is  not,  indeed,  pretended,  that  this  view 


46  Observations  on  Yellow  Fever. 

of  the  subject  is,  in  any  respect,  new.  Many  of 
the  most  enlightened  physicians  have  long  since 
perceived  this  coincidence  of  facts,  and  have  ac- 
cordingly prosecuted  the  comparison  to  a  con- 
siderable extent.  It  only  remains,  therefore,  at 
present,  to  inquire  whether  this  analogy  may  not 
properly  be  carried  still  further,  and  whether  it 
will  not  suffice  to  unfold  a  number  of  intricate  and 
important  circumstances  of  that  form  of  pestilence 
which  has  lately  produced  so  much  distress  and 
mortality  in  the  United  States. 

If  this  comparative  view  of  miasmata  and  poi- 
sons terminated  merely  in  speculation,  however 
curious  or  unexpected  many  of  the  coincidences 
might  appear,  the  publication  of  it  would  scarcely 
accord  with  the  existing  importance  of  the  sub- 
ject ;  but,  believing  that  many  practical  infer- 
ences, respecting  pestilential  epidemics,  may  be 
deduced  from  such  a  comparison  of  facts,  I  have 
thought  proper  to  lay  it  before  the  public,  in  or- 
der to  be  corrected  or  approved  by  my  medical 
readers. 

To  prevent  misapprehension,  it  will  be  proper 
to  state,  that,  at  present,  no  discussion  will  be 
undertaken  concerning  the  origin,  domestic  or 
foreign,  of  pestilential  epidemics  ;  the  quality  of 
contagion  attributed  to  them  ;  nor  the  nrecise 
chemical     constitution    of    the    morbid    cause. 


Observations  on  Yellow  Fever.  47 

These  topics,  though  certainly  of  the  highest 
concern  to  our  country  and  to  mankind,  have 
been  so  ably  treated  by  several  writers,  that  it  is 
the  less  necessary  now  to  renew  the  consideration 
of  them. 

Before  proceeding  to  an  account  of  the  opera- 
tion of  poisons,  it  will  be  proper  to  state  some  of 
the  causes  which  prevent  the  general  acknowledg- 
ment of  the  analogy  between  them  and  the  infec- 
tious matter  of  pestilence. 

The  first  which  deserves  to  be  mentioned  is 
the  gaseous  and  invisible  state  of  pestilential  mi- 
asmata. When  poisons  are  spoken  of,  they  are 
generally  understood  to  mean  certain  visible  and 
palpable  substances,  of  mineral  or  vegetable  ori- 
gin, or  injected  into  the  system  by  some  venom- 
ous animal.  The  conveyance  of  any  of  those 
substances  into  the  stomach,  or  the  bite  of  the 
venomous  animal,  is  considered  as  the  signal  of 
approaching  mischief.  And  this  relation  between 
cause  and  effect  is  usually  so  obvious  and  uniform 
as  to  be  recognized  even  by  the  most  careless 
and  ignorant  part  of  mankind.  All  this,  however, 
fails  in  the  aerial  form  of  the  noxious  power  pro- 
ducing malignant  diseases,  which,  in  a  great  mea- 
sure, escapes  the  observation  of  the  senses,  and  is 
chiefly  to  be  known  by  its  effects. 


48  Observations  on  Yellow  Fever. 

Another  cause  of  overlooking  the  analogy  con- 
tended for,  is  the  more  frequent  suddenness  of 
death  from  poisons,  produced  by  the  largeness  of 
the  dose,  which  stimulates  beyond  the  point  of 
fever,  and  quickly  overpowers  and  extinguishes 
the  operations  of  the  vital  principle.  By  diminish- 
ing the  quantity  to  an  appropriate  amount,  these 
noxious  substances  may  be  made  to  exhibit  the 
course,  duration,  and  nearly  all  the  phenomena  of 
what  is  called  a  malignant  fever. 

But,  abbve  all,  the  attention  of  physicians  has 
been  diverted  from  this  analogy  between  miasmata 
and  poisons,  by  the  febrile  part  of  the  character 
which  generally  belongs  to  pestilential  diseases, 
and  which,  in  common  apprehension,  is  constant- 
ly connected  with  them.  Yet  these  diseases  are 
by  no  means  universally  accompanied  with  what 
is  strictly  called  fever.  There  is  often  a  degree 
of  virulence  in  the  Asiatic  plague,  in  the  yellow 
fever,  and  in  all  the  other  forms  of  pestilential  and 
malignant  diseases,  which  altogether  transcends 
the  process  of  fever,  and  extinguishes  life  in  a 
more  summary  manner.  In  the  worst  cases,  both 
of  poison  and  pestilence,  the  febrile  part  of  the 
symptoms  excites  little  attention.  After  all  our 
researches  into  the  nature  of  fever,  it  seems  pri- 
marily to  consist  in  the  stimulation  by  poison, 
miasmata,  or  otherwise,  of  a  particular  part  of  the 
system,  and  in  the  propagation  of  morbid  affection 


Observations  on  Yellow  Fever.  49 

afterwards,  from  the  viscus  or  part  originally  in- 
vaded, to  the  heart  and  arteries,  and  other  parts 
of  the  body.  If  this  be  just,  according  to  the 
theory  of  a  celebrated  writer,*  fever  is  merely  to- 
pical at  first,  and  subsequently  a  disease  of  asso- 
ciation. The  morbid  cause,  how  varied  soever, 
whether  contagion  or  miasma,  whether  alternation 
of  temperature,  or  other  noxious  power  operating 
in  a  similar  way,  appears  always  to  act  upon  the 
same  principle  :  it  stimulates,  directly  or  indirect- 
ly, a  particular  portion  of  the  system,  in  a  less  or 
greater  degree  ;  sometimes  to  the  extent  of  com- 
mon inflammation,  sometimes  to  inflammation  siri 
generis,  then  to  more  violent  inflammation  verging 
rapidly  to  gangrene,  and,  lastly,  to  the  extent  of 
paralysis.  The  part  thus  variously  affected, 
through  the  medium  of  sympathetic  association, 
propagates  disease  to  other  parts  of  the  system, 
and  especially  to  the  heart  and  arteries.  This 
association  may  be  more  or  less  comprehensive, 
and  thereby  render  the  fever  more  simple  or  com- 
pound. And  upon  certain  peculiarities  of  struc- 
ture, or  the  greater  or  less  importance  of  the  part 
primarily  attacked,  and  upon  the  more  or  less 
compound  nature  of  the  disease,  resulting  from 
the  extent  of  association,  will  probably  depend 
the  character  of  the  fever,  as  to  mildness  or  ma- 
lignancy. 

*  Dr.  Darwin. 

G 


50  Observations  on  Yellow  Fever. 

Examples  of  this  may  be  found  in  cases  of 
pneumonia  and  yellow  fever.  In  the  former,  a 
local  inflammation  of  the  lungs,  the  effect  of  ex- 
posure  to  alternation  of  temperature,  excites  fe- 
brile action  throughout  the  sanguiferous  system : 
in  the  latter,  miasmata,  received,  as  there  is  com- 
monly reason  to  conclude,  into  the  stomach,  first 
attack  that  important  organ,  and,  soon  afterwards, 
draw  into  morbid  sympathy  various  parts  of  the 
head,  limbs,  back,  &x.  then  the  heart  and  arteries, 
and,  successively,  many  other  parts  of  the  body. 
Hence  it  appears  that  fever  is  originally  local ;  and 
though,  in  its  progress,  it  be  extended  over  the 
whole  body,  we  are  still  to  regard  it  chiefly  as 
symptomatic  of  the  stimulus  applied  to  a  particular 
part.  If  a  sword  penetrate  the  abdomen,  and 
transfix  the  stomach,  the  range  of  sympathy  pos- 
sessed by  this  viscus  will  draw  on  a  train  of  se- 
vere consequences,  such  as  pain,  inflammation, 
fever,  convulsions,  gangrene,  &c.  In  this  case 
the  convulsions  and  the  fever  are  equally  symp- 
tomatic of  the  wound  ;  and,  by  attending  princi- 
pally to  these,  and  overlooking  the  organic  injury, 
we  should  act  as  is  common  in  pestilential  dis- 
eases, where  the  force  and  rapidity  of  the  action 
of  the  blood-vessels  are  deemed  of  more  impor- 
tance than  the  local  poison  which  inflames,  cor- 
rodes, or  paralyses  a  vital  organ. 

After  this  digression,  which,  however,  the  rea- 


Observations  on  Yellow  Fever.        •    51 

der  will  observe  to.be  essentially  connected  with 
the  subject  before  us,  it  is  proper  to  return  to  the 
operation  of  poisons.  There  can  be  little  danger 
of  a  mistake  of  terms  in  the  treatment  of  this  sub- 
ject ;  but,  to  prevent  this,  it  may  be  observed, 
that  the  word  poison  is  simply  used  to  designate 
a  substance  which  injures  or  destroys  life  by  a 
small  quantity,  generally  in  a  short  time,  and  by 
a  mode  of  action  not  obvious  to  the  senses. 
These  substances,  according  to  their  origin,  are 
divided  into  mineral,  vegetable,  and  animal ;  and, 
though  much  diversity  will  be  observed  in  com- 
paring them,  yet  there  seem  to  be  some  general 
principles  in  which  they  all  remarkably  agree. 
To  the  divisions  of  poisons  just  mentioned,  a 
fourth,  viz.  the  aerial,  has  been  added  ;  and  if 
the  opinion  maintained  in  this  paper  has  any  foun- 
dation, the  propriety  of  such  addition  will  be  suf- 
ficiently apparent.  Indeed,  according  to  this 
opinion,  miasmata  are  truly  poisons  ;  but,  for  the 
sake  of  discrimination,  the  usual  terms  of  distinc- 
tion will  still  be  preserved. 

Of  the  mineral  poisons  it  will  be  only  necessary 
to  mention  a  few,  and  such  as  most  frequently 
fall  under  notice.  The  oxyd  of  arsenic  (common 
white  arsenic,)  the  muriate  of  mercury  (corrosive 
sublimate,)  and  the  acetite  of  copper  (verdigrise,) 
are  familiar  to  every  body.  The  effects  of  these 
substances,  when  taken  into  the  stomach,  are  nau- 


52  Observations  on  Yellow  Fever, 

sea,  vomiting,  burning  heat  and  pain  referred  to 
the  stomach,  sense  of  distention,  violent  griping 
and  burning  pains  of  the  intestines,  which  are 
sometimes  costive,  sometimes  affected  with  pur- 
ging ;  the  discharge  of  a  slimy  and  frothy  matter, 
often  mixed  with  blood,  by  vomit  and  stool ;  in- 
supportable thirst;  pains  and  cramps  in  the  limbs  ; 
pains  in  the  back  ;  flushing  of  the  face  ;  the  pulse 
at  first  full,  strong,  and  frequent :  in  the  progress 
of  the  disease,  hiccup  and  convulsions  take  place; 
haemorrhages  appear  from  various  sources;  the  vi- 
olent retchings  become  aggravated,  attended,  to- 
wards the  close,  with  vomiting  of  dark-coloured 
or  black  matter ;  *  red  or  dark  spots  appear  on 
the  skin  ;    sudden  prostration  of  strength,  weak 

*  A  man  took,  by  mistake,  a  drachm  of  white  arsenic  in- 
stead of  cream  of  tartar.  The  usual  symptoms  came  on — 
thirst,  heat  at  the  stomach,  vomiting,  hiccup,  weak,  slow  and 
intermittent  pulse  ;  the  matter  puked  up-  bilious  and  dark- 
coloured  :  on  the  fourth  day  he  was  attacked  with  haemorr- 
hagy  ;  on  the  seventh  he  was  affected  with  violent  priapism ; 
on  the  eighth  he  was  seized  with  more  distressing  anxiety — 
Ins  pulse  was  febrile,  full,  and  intermittent — convulsions 
came  on — delirium  and  death.  On  dissection,  the  stomach 
was  found  deprived  of  the  villous  coat,  and  full  of  a  black 
liquor,  which  deposited  a  sediment  like  powdered  charcoal. 
See  Nosologic  Methodique  de  Sauvagcs,  tome  iii.  p.  112. 

Similar  cases,  especially  as  to  black  vomiting  and  the 
other  more  important  symptoms,  may  be  found  in  Wepfer 
(Historia  Cicuta?  Aquatica?,)  in  Morgagni  (De  Sed.  et  Causis 
Morb.,)  and  in  many  other  writers. 

A  fatal  case  of  poison  by  arsenic  also  occurred,  some  time 


Observations  on  Yellow  Fever.  53 

pulse,  tremblings,  cold  sweats  and  cold  extremi- 
ties, commonly  usher  in  death.  A  rapid  putre- 
faction begins  very  soon  after  death,  and  renders 
speedy  interment  indispensable.  Dissection  dis- 
covers marks  of  violent  inflammation  and  erosion 
of  the  stomach,  and  the  collection  of  a  large  quan- 
tity of  the  matter  of  black  vomiting.  In  cases 
where  persons  have  survived  the  taking  of  poison- 
ous doses  of  arsenic,  the  hair  has  been  observed 
to  fall  off,  and  a  jaundice  of  the  worst  and  most 
obstinate  kind  has  taken  place. 

The  vegetable  poisons  are  so  numerous,  and 
most  of  them  so  well  known,  that  it  is  unneces- 
sary, at  present,  to  recount  them.  They  produce, 
when  taken  in  a  given  quantity  into  the  stomach, 
high  febrile  action,  heat  and  redness  of  the  skin, 
especially  of  the  face,  neck  and  «breast,  redness 
and  despondency  of  the  eyes,  furred  and  dry 
tongue,  anxiety  and  restlessness,  sense  of  heat 
and  sickness  at  stomach,  vomiting,  oppression 
and  pain  about  the  prsecordia,  pain  in  the  head, 
giddiness  and  staggering,  delirium,  hiccup,  con- 
vulsions, subsultus  tendinum,  dilatation  of  the 
pupils  of  the  eyes,  stupor,  sometimes  yellowness 
of  the  skin,  haemorrhages,  black  vomiting,  black 

ago,  in  the  New-York  Hospital.  Pew  of  the  circumstances 
can  now  be  recollected  ;  but  black  vomiting  came  on — and 
the  patient  died  about  the  sixth  day. 


54  Observations  on  Yellow  Fever. 

and  pitch-like  stools,  &c.  and  after  death,  some- 
times before,  livid  spots  are  observed  on  the  body, 
the  appearance  of  the  blood  is  dark  and  dissolved, 
and  putrefaction  speedily  takes  place.* 

The  animal  poisons  are  generally  communica- 
ted by  means  of  the  bite  or  sting  of  the  venomous 
animal.  They  induce  a  variety  of  phenomena, 
which  it  is  not  necessary  minutely  to  state.  The 
bite  of  the  poisonous  serpents  is  generally  follow- 
ed by  tumour,  and  livid  colour  of  the  part  bitten, 
extravasation  of  dark-coloured  blood  into  the  ad- 
jacent cellular  membrane,  nausea  and  vomiting, 
sudden  prostration  of  strength,  paralysis  of  the 
limbs,  convulsions,  yellowness  of  the  skin,  hae- 
morrhages, &c.  Livid  appearances  of  the  body, 
a  dark-coloured  and  dissolved  state  of  the  blood, 
and  a  rapid  putrefaction,  are  observed,  after 
death,  f 

The  most  transient  consideration  of  the  symp- 
toms just  recited  cannot  fail  to  impress  the  reader 
with  the  striking  analogy  between  the  operation  of 
poisons  and  the  miasmata  and  contagions  which 
produce  epidemic  and  pestilential  diseases. 
Scarcely  a  single  symptom  belonging  to  malig- 
nant distempers  can  be  mentioned,  which  does 
not  also  appear  as  a  consequence  of  the  reception 

*  See  Wepfer  (Historia  Cicutae  Aquaticae.) 
f  Fontana  (Treatise  of  the  Venom  of  the  Viper.) 


Observations  on  Yellow  Fever.  55 

of  poison  ;  and,  particularly,  the  most  deadly 
symptoms  observed  in  the  one  form  of  disease, 
are  also  found  to  be  common  to  the  other. 

It  may  be  objected  that  the  deleterious  effects 
of  poisons  are  not  so  regularly  attended  with  fe- 
brile appearances  as  our  pestilential  epidemics. 
But,  in  answer  to  this,  it  should  be  observed,  that 
the  irregularity  of  malignant  and  pestilential  dis- 
eases, with  respect  to  the  circumstances  of  fever, 
has  been  always  remarked  by  the  best  practition- 
ers ;  that  the  absence  of  the  cold  stage  at  the  be- 
ginning, and  of  the  hot  stage  of  fever  afterwards, 
is  remarked  among  the  signs  of  malignancy  ;  and 
that  some  of  the  worst  cases,  instead  of  frequency 
of  pulse  and  increased  heat,  exhibit  a  wonderful 
reduction  of  both.  The  conclusion,  therefore,  is, 
that  only  the  lighter  cases  of  pestilence  are  unlike 
the  effects  of  poison  ;  and  that  in  proportion  to 
the  degree  of  malignity  the  resemblance  grows 
stronger.  It  must  be  admitted,  indeed,  that  the 
gross  matter  of  mineral  poisons  often  acts  upon 
the  alimentary  canal,  especially  in  its  first  opera- 
tion, after  a  manner  which  cannot  be  predicated 
of  the  subtle  form  of  miasmata  ;  but  progressively 
the  difference  is  much  reduced  ;  and,  towards  the. 
close  of  these  diseases,  is  nearly  lost. 

The  morbid  condition  of  the  stomach,  induced 
by  all  the  mineral  and  vegetable  poisons  received 
into  that  organ,  and  in  like  manner  by  the  miasmata. 


56  Observations  on  Yellow  Fever. 

of  pestilence,  seems  to  be  the  original  source  of 
the  analogy  now  attempted  to  be  established. 
All  these  noxious  powers,  however  various  in 
constitution  and  origin,  concur  in  possessing  a 
stimulant  operation  so  violent  as  to  cause  inflam- 
mation, paralysis,  or  decomposition  in  this  vital 
part.  The  effect  of  such  a  stimulus  on  the  ali- 
mentary canal  itself,  will  readily  explain  all  the 
symptoms  of  irregular  action  whLh  take  place  in 
that  organ  ;  and  the  sympathetic  associations  of 
the  stomach  with  other  parts  will  explain  the  af- 
fections of  the  head,  limbs,  &c.  as  well  as  the 
rapid  exhaustion  of  the  principle  of  life  so  often 
observed. 

There  is  one  remarkable  phenomenon  in  the 
history  of  yellow  fever,  which  seems  to  have  no 
parallel  but  in  the  operation  of  poisons  received 
into  the  stomach.  I  mean  the  retrocession  of  the 
high  febrile  and  inflammatory  symptoms  of  the 
disease,  which  often  takes  place  about  the  third 
or  fourth  day,  and  leads  the  inexperienced  obser- 
ver, and  the  deluded  patient,  to  confide  in  the 
hopes  of  recovery.  If  any  symptom  can  be  said 
to  distinguish  the  yellow  fever  from  other  forms 
of  pestilence,  this  deserves,  perhaps,  the  most  to 
be  selected ;  and  the  cases  related  below,  would 
lead  to  a  belief,  that  certain  mineral  and  vegetable 
poisons  operate  in  a  very  similar  manner.* 

*  A  physician  of  this  city,  some  time  ago,  was  requested 


Observations  on  Yelloxv  Fever.  57 

The  evidence  of  dissections  strongly  confirms  the 
similarity  of  the  operation  of  poisons  and  miasmata. 
By  these  it  appears,  that  in  yellow  fever  the  sto- 
mach and  duodenum  generally  sustain  the  first 

to  visit  a  child,  who,  by  mistake,  had  swallowed  a  strong 
solution  of  the  muriate  of  mercury.  Some  barley-water, 
which  happened  to  be  at  hand,  was  immediately  given  in 
large  quantity,  and  the  contents  of  the  stomach  were  ejected 
by  vomiting  within  four  minutes  after  swallowing  the  poison. 
The  following  night  the  child  passed  a  good  deal  of  blood  by 
vomiting  and  stool,  succeeded  by  violent  griping  pains.  On 
the  second  day  these  symptoms  had  entirely  gone  off ;  but 
some  fever  and  cough  (a  complaint  which  the  child  laboured 
under  before  taking  the  poison)  had  returned,  for  which  a  de- 
mulcent remedy,  with  laudanum,  was  ordered.  On  the  third 
day  the  fever  and  cough  were  so  severe  that  it  was  thought 
proper  to  apply  a  blister  to  the  sternum.  After  this  all  com- 
plaints vanished,  and  the  child  appeared  to  be  fast  recovering. 
When  this  favourable  state  had  continued  some  time,  the  pa- 
tient began  to  vomit  a  dark-coloured  matter — the  pulse  be- 
came more  frequent,  irregular  and  weak — the  intellectual 
functions  were  impaired — convulsions  soon  succeeded — a 
frantic  delirium  came  on — and  death  took  place  on  the  fifth 
day. 

A  young  woman  dined  upon  a  dish  containing  a  poisonous 
species  of  mushroom,  (Agaricus  Clypeatus,  Lin.)  In  the 
afternoon  she  was  attacked  with  cardialgia — in  the  eve- 
ning she  felt  acute  pains — nausea  and  vomiting  came  on,  at- 
tended with  bilious  stools  and  great  prostration  of  strength. 
On  the  second  day  her  pulse  was  frequent  and  small,  and  the 
epigastrium  was  swelled.  Demulcent  remedies,  fomentations 
and  clysters  were  ordered — many  stools  were  procured,  and 
-several  pieces  of  the  mushroom  discharged,     On  the  third 

H 


58  Observations  on  Yellow  Fever. 

and  most  violent  impression  of  the  miasmata  ; 
that  they  suffer  by  means  of  this  stimulus,  inflam- 
mation, paralysis,  or  corrosion  ;  and  that  they  ex- 
hibit a  destruction  of  the  villous  coat,  and  an  ac- 

day  the  cardiaJgia  and  debility  continued.  On  the  fourth  day 
the  patient  was  easy  through  the  night — the  skin  was  moist, 
and  tlie  pulse  better  ;  and,  after  taking  some  further  remedies, 
she  voided  more  of  the  mushroom  :  the  symptoms  then  aba- 
ted, and  she  slept.  On  the  fifth  day  she  was  seized  with  de- 
lirium, oppression  of  the  breast,  sighing,  anxiety,  &.c.  her 
pulse  failed — she  refused  all  remedies — her  extremities  be- 
came cold — the  difficulty  of  breathing  increased — she  was 
seized  with  locked  jaw — and  yellowness  appeared  on  some 
parts  of  the  skin.  On  the  sixth  day  the  patient  died.  On 
dissection,  the  stomach  was  found  to  be  affected  with  inflam- 
mation, the  duodenum  distended  with  flatus,  and  the  bile  of 
the  gall-bladder  green  and  black. 

See  Nosologic  Methodique  de  Sauvages,tome  iii.  p.  115. 

The  following  case,  related  by  Dr.  Percival,  proceeded  so 
insidiously  as  to  deserve  to  be  mentioned  here  ;  though,  for 
the  sake  of  rendering  it  brief,  much  of  the  detail  is  abridged. — 
A  young  lady  ate  a  large  quantity  of  pickled  samphire — this 
produced  pain  in  the  stomach  and  eruption  on  the  skin — she 
was  affected  with  shooting  pains  over  the  body,  was  dejected, 
restless,  and  very  thirsty — her  pulse  was  frequent  and  small, 
the  tongue  covered  with  a  white  fur,  and  she  passed  several 
days  without  a  stool.  On  the  sixth  day,  vomiting  came  on, 
preceded  by  hiccup.  On  (he  7th,  the  retchings  became  in- 
cessant, and  the  discharges  of  a  green  colour  and  very  offen- 
sive— progressively  the  discharges,  both  by  stool  and  vom- 
iting, were  more  and  more  offensive,  and  the  latter  assumed 
a  dusky  green  colour.  Upon  using  some  remedies,  the 
symptoms  were  suspended  ;  but  in  2i  hours  the  vomiting  re- 


Observations  on  Yellow  Fever.  59 

cumulation  of  black  matter,  exactly  resembling 
those    which  arise  from   the   mineral   poisons,* 

turned,  the  extremities  became  cold,  and  she  expired  on  the 
tenth  day. — On  dissection,  about  a  quart  of  brown  and  foetid 
liquor  was  found  in  the  stomach  ;  the  internal  coat  of  that 
organ  was  inflamed  and  gangrenous,  particularly  about  the 
cardia  and  pylorus;  and  this  appearance  extended  itself 
someway  down  the  duodenum. — By  the  usual  chemical  tests, 
the  pickled  samphire  was  found  very  strongly  impregnated 
with  copper.  See  'Essays  Medical,  Philosophical  and  Exper- 
imental, vol.  ii.  p.  122. 

*  The  stomach  and  the  beginning  of  the  duodenum  are 
the  parts  that  appear  most  diseased.  In  two  persons,  who 
died  of  the  disease  on  the  fifth  day,  the  villous  membrane  of 
the  stomach,  especially  about  its  smaller  end,  was  found  highly 
inflamed  ;  and  this  inflammation  extended  through  the  py- 
lorus into  the  duodenum  some  way.  The  inflammation  here 
was  exactly  similar  to  that  induced  in  the  stomach  by  acrid 
poisons,  as  by  arsenic,  which  we  have  once  had  an  opportuni- 
ty of  seeing  in  a  person  destroyed  by  it.  See  Dissections  by 
Doctors  Physic  and  Calhrall,  in  Dr.  Rush's  Account  of  the 
Yellow  Fever  of  1793,  p.  120. 

The  internal  part  of  the  stomach  and  duodenum  is  some- 
times reddish  or  yellow,  but  often  blackish  ;  the  tunica  vil- 
[osa  very  easily  separating,  even  with  the  touch  ;  the  other 
guts  much  in  the  same  state  :  but,  in  general,  the  two  first 
most  affected.  In  the  stomach  there  is  often  a  thick  mucus, 
with  the  same  black  stuff*  that  is  thrown  up  by  vomit  :  if  the 
villous  coat  is  not  much  affected,  the  mucus  prevails  ;  but  if 
otherwise,  the  black  vomit.  Farther  down  the  guts,  the  black 
stuff  is  thicker  and  more  viscid,  almost  resembling  tar  ;  and, 
in  the  great  guts,  it  is  often  mixed  with  clotted  blood.  See 
Hunter's  Di.iea.irs  nf  the  Army,  p.  201. 


60  Observations  on  Yellow  Fever. 

The  morbid  appearances  observed  in  other  viscera, 
and  especially  the  effusions  of  blood  and  serum, 
seem  more  probably  to  result  from  the  general 
violence  of  arterial  action  ;  and  the  livid  and  black 
spots  which  are  often  discovered  on  the  lungs  and 
elsewhere,  correspond  with  similar  spots  on  the 
lungs  of  animals  that  die  of  poisons,  and  which  are 
ascribed  to  the  universally  morbid  state  of  the 
blood.  The  burning  heat  in  the  stomach,  as  well 
as  the  nausea  and  vomiting,  at  the  attack  of  yellow 
fever  ;  the  strong  traces  of  inflammation  in  that  or- 
gan when  laid  open  to  view ;  the  injuries  of  the 
villous  membrane;  the  black  matter  overspreading 
its  surface  ;  and  the  extension  of  these  morbid  ap- 
pearances to  some  distance  in  the  duodenum,  all 
seem  to  denote  the  presence  and  immediate  ap- 
plication of  virus  to  the  coat  of  the  stomach.  Other 
circumstances  also  corroborate  this  opinion.  The 
obstinate  costiveness  which  appears  at  the  begin- 
ning of  the  disease  ;  the  deficiency  of  bile  in  the 
violent  cases  ;  and,  finally,  the  scantiness  and  vis- 
cidity of  that  liquor,  discovered  in  dissecting  the 
gall-bladder,  must,  I  conceive,  be  attributed  to 
excessive  stimulation,  and,  of  consequence,  to  a 
morbid  degree  of  absorption  in  the  alimentary  ca- 
nal. It  may  be  objected  to  the  opinion  of  the  op- 
eration of  miasmata  in  producing  inflammation, 
paralysis,  or  corrosion  in  the  primae  vice,  that  symp- 
toms characterizing  these  affections  do  not  always 
appear  in  yellow  fever,  and  that  sometimes  thev 


Observations  on  Yellow  Fever.  6 1 

do  not  appear  at  all,  in  cases  where  the  greatest 
organic  destruction  of  the  stomach  had  taken  place. 
But  it  may  be  replied  that  nothing  is  more  prob- 
able than  fallacy  on  this  subject.  Inflammation, 
in  the  most  fatal  degree,  may  exist  in  the  stomach 
without  fever,  pain  or  vomiting;*  and  paralysis 
may  be  produced  in  that  organ,  in  a  moment  of 
time,  without  being  perceived,  f  A  cancerous  af- 
fection of  the  stomach  has  been  found,  by  dissec- 
tion, to  exist,  which  had  never  been  indicated  by 
nausea  orretchings.J  And  Morgagni  (Seats  and 
Causes  of  Diseases,  vol.  iii.  p.  374)  relates  a  case 
of  a  dose  of  arsenic  proving  fatal,  where  no  inflam- 
mation, erosion,  or  other  mark  of  mischief,  ap- 
peared in  the  stomach  :  yet  the  poisonous  material 
was  actually  found  in  contact  with  the  coat  of  the 
stomach  ;  was  verified  by  the  usual  chemical  and 
other  tests,  and  one  of  its  effects  displayed  in  the 
appearance  of  lived  maculae  on  the  skin. 

Dr.  De  Witt,  in  a  very  judicious  account  of  the 
poisonous  effects  of  the  datura  stramonium  (see 
Med.  Rep.  vol.  ii.  p.  27,  3rd  edition,)  has  noticed 
the  resemblance  of  these  effects  to  the  symptoms 
of  malignant  fevers. 

*  Cullen's  First  Lines,  vol.  i.  p.  205. 
f  Zoonomia,  vol.  iii.  (American  edition)  p.  269. 
\  Duncan's  Medical  Commentaries,  vol.  iii.  (2d  Decade) 
p.  146. 


62  Obseroations  on  Yellow  Fever. 

The  production  of  yellowness  of  the  skin,  by  cer- 
tain poisonous  vegetables,  and  by  the  bite  of  spi- 
ders, serpents,  &  •.  (see  Nosologic  Methodique  dc 
Sauvages,  tome  iii.  p.  448,)  as  well  as  in  malig- 
nant fevers,  is  a  striking  proof  of  the  same  analogy. 

The  relation  which  the  disease  produced  by  the 
bite  of  a  rabid  animal  bears  to  malignant  fevers, 
is  ably  illustrated  by  Dr.  Rush,  in  his  observations 
on  the  nature  and  cure  of  hydrophobia.  See 
Medical  Inquiries  and  Observations,  vol.  v. 

The  condition  of  the  blood,  as  inspected  after 
the  operation  of  poisons  and  miasmata,  affords 
strong  evidence  of  the  similarity  of.  their  effects. 
The  most  distinguished  compilers  of  fas  ts  on  the 
subject  of  poisons,  such  as  Wepfer,  Mead,  Fon- 
tana,  &c.  generally  represent  the  blood,  after  the 
system  has  been  acted  upon  by  mineral,  vegetable, 
and  animal  poisons,  as  morbidly  thin,  dark-colour- 
ed, and  indisposed  to  the  usual  manner  of  coag- 
ulation. That  a  similar  state  of  the  blood  is  gene- 
rally found  in  the  malignant  cases  of  yellow  fever 
will  not  be  denied.  The  livid  maculae  and  uni- 
versal duskiness  of  the  skin,  the  haemorrhages  from 
various  sources,  and  the  rapid  putrefaction  of  dead 
bodies,  are  all  common  effects  of  miasmata  and 
poisons  ;  and  that  the  last,  especially,  is  a  com- 
mon consequence  of  the  operation  of  a  violent 
stimulus,  is  proved  by  its  occurrence  after  death 


Observations  on  Yellow  Fever.  63 

by  lightning,  the  fatigue  of  the  chace,  &c.  The 
subject,  however,  of  the  morbid  changes  of  the 
blood  has  not  been  sufficiently  explored  ;  and  may 
be  expected,  hereafter,  to  yield  important  instruc- 
tion concerning  the  action  of  these  noxious  pow- 
ers. 

Flushing  of  the  face,  neck  and  breast,  redness 
of  the  eyes,  and  heat  in  the  eye-balls,  are  remark- 
able symptoms  at  the  beginning  of  yellow  fever. 
They  are  the  usual  effects  of  vegetable  and  other 
poisons  taken  into  the  stomach.  They  are  obser- 
ved, in  a  considerable  degree,  after  taking  many 
stimulant  substances,  not  poisonous,  into  the  sto- 
mach ;  and  redness  of  the  eyes,  especially,  is  a  well 
known  consequence  of  the  intoxication  of  opium 
and  ardent  liquors.  It  seems  to  be  the  effect  and 
sign  of  a  want  of  absorption  in  the  capillary  veins, 
induced  by  an  exhaustion  of  vital  power,  from  the 
operation  of  some  excessive  stimulant. 

It  was  before  stated,  that  a  falling  off  of  the 
hair  has  been  a  frequent  consequence  of  the  poison 
of  arsenic.  The  occurrence  of  the  same  thing  af- 
ter malignant  fevers  deserves  to  be  recollected  in 
this  comparison  of  these  diseases. 

Among  other  consequences  of  an  'excessive 
dose  of  arsenic  mentioned  before,  is  a  liableness 
to  frequent  attacks  of  jaundice.     A  gentleman. 


64  Observations  on  Yellow  Fever. 

previously  remarkable  for  his  athletic  powers,  Was 
nearly  deprived  of  life  by  this  poison,  and  after- 
wards exhibited  all  the  appearances  of  a  broken 
constitution.  Soon  after  this  misfortune,  he  was 
seized  with  a  disease  of  the  liver,  followed  by 
paralysis  ;  and  thenceforward  was  subject  to  jaun- 
dice four  or  five  times  every  year. 

The  analogy  between  the  miasmata  of  pesti- 
lence, and  mineral  as  well  as  vegetable  poisons, 
will  likewise  appear  interesting,  if  we  consider 
the  passages  by  which  they  gain  admittance  into 
the  body.  Three  passages  have  been  assigned 
for  the  reception  of  miasmata  ;  that  by  the  lungs 
in  respiration — another  by  the  cutaneous  absorb- 
ents— and  a  third  by  the  oesophagus  and  stomach. 
The  reception  by  the  lungs  would  appear  prob- 
able at  first  view,  and,  from  the  actual  approach  of 
yellow  fever  under  the  form  of  catarrh  in  many  in- 
stances, no  doubt  can  be  entertained  of  the  fact. 
But  though  miasmata  may  find  entrance  by  the 
iungs,  and  many  cases  of  pestilence  be  disguised  by 
the  mask  of  catarrh  ;  yet  we  can  by  no  means  pro- 
nounce this  the  usual  inlet  of  the  cause  of  yellow 
fever.  The  cases  of  primary  and  continued  affec- 
tion of  the  lungs,  in  this  disease,  are  comparatively 
rare.  The  continuance  of  any  single  portion  of 
air  in  the"  vesicles  of  the  bronchia  must  be  neces- 
sarily short ;  and  the  quick  return  of  it,  aided  by 
the  exhalation  of  moisture  which  alwavs  accom- 


Observations  on  Yellow  Fever.  65 

panies  the  act  of  expiration,  must  greatly  dilute 
and  expel  any  matter  of  infection  which  had  ob- 
tained admittance.  The  noxious  gas  probably 
adheres  to  the  vapour  of  water  wherever  they 
meet,  and  thus  the  halitus  of  the  lungs  proves  to 
be  one  of  the  best  means  of  defence  against  this 
aerial  poison. 

That  miasmata  are  absorbed  by  the  skin,  is 
rendered  probable  by  a  multitude  of  facts.  The 
course  of  inflamed  lymphatics  has  served  to  trace 
the  conveyance  of  a  fever-producing  poison  from 
a  gangrene  in  the  lower  extremities.  In  a  similar 
manner  an  old  ulcer  of  the  leg  has  been  often 
known  to  furnish  matter  of  infection,  which  pass- 
ing upwards,  excited  a  swelling  in  the  groin,  and 
a  consequent  fever.*  It  is  probable  that  the  pes- 
tilence of  the  Levant  is  often  communicated  by 
Gutaneous  absorption,  which  affords  the  best  so- 
lution of  the  glandular  swellings  in  that  disease, 
and  leads  to  the  supposition,  that  such  swellings 
indicate  the  route  of  miasmata  into  the  system, 
rather  than  any  critical  effort  of  nature  to  discharge 
them.  Hence  may  be  explained  the  efficacy  of 
oil  applied  to  the  skin  in  this  kind  of  pestilence. 
The  oil  not  only  destroys  such  miasmata  as  still 
adhere  to  the  skin,  but,  pursuing  and  overtaking 
such  as  have  found  admittance  into  the  lympha- 

*  See  Hunter's  Diseases  of  the  Army,  p.  1 86. 
I 


66  Observations  on  Yellow  Fever. 

tics,  it  guards  the  system  from  the  mischief  which 
otherwise  might  ensue.  There  is  ground  to  be- 
lieve, that  miasmata  are  heavy  and  sluggish,  that 
they  commonly  lurk  near  the  earth,  and  that  they 
are  most  virulent  near  to  their  source.  Hence 
we  may  account  for  Dr.  Russel's  fact  of  inguinal 
swelling  occurring  so  much  oftener  in  the  plague 
than  the  axillary,  parotid,  cervical,  and  maxilla- 
ry :f  hence,  likewise,  we  may  account  for  another 
fact  mentioned  by  him,  viz.  that  the  inguinal  bu- 
bo of  the  plague  appears  lower  down  the  thigh 
than  that  of  the  venereal  disease,  and  nearer  to 
the  crural  vessels  ;  and  hence,  finally,  we  may 
explain  the  appearance  of  pestilence  in  dogs, 
males,  and  other  animals  holding  their  heads  near 
the  earth,  sooner  than  in  man.  But  as  these 
glandular  swellings  rarely  occur  in  yellow  fever, 
it  must  be  concluded,  that  the  cause  of  that  dis- 
ease generally  finds  admittance  into  the  system 
through  some  other  route. 

The  comparative  infrequency  of  pulmonary 
symptoms,  as  well  as  of  buboes  and  carbuncles 
in  yellow  fever,  compels  us  to  seek  for  the  route 
of  the  morbid  cause  in  the  oesophagus  and  sto- 
mach. If  the  evidence  in  favour  of  this  opinion 
be  duly  considered,  it  will  be  difficult  to  avoid  the 
conclusion.      The  first  morbid  sensations,  at  the 

f  Treatise  of  the  Plague,  p.  113. 


Observations  on  Yellow  Fever.  67 

approach  of  yellow  fever,  may  be  generally  refer- 
red to  the  stomach,  and  to  those  parts  with  which 
the  stomach  maintains  the  strongest  association  of 
motions.  In  the  progress  of  the  disease,  this  or- 
gan continues  to  suffer  far  more  than  is  usual  in 
other  malignant  distempers  :  and,  towards  the 
close  of  the  tragedy,  black  vomiting,  the  result  of 
decomposition  as  well  as  of  morbid  secretion,  and 
yellowness  of  the  skin,  the  effects  of  virulence  ex- 
erted on  one  of  the  nearest  appendages  of  the  sto- 
mach, furnish  the  two  symptoms  which,  more  than 
any  others,  have  conferred  on  the  disease  its  po- 
pular denominations.  The  miasmata  of  this  form 
of  pestilence,  mixed  with  the  saliva,  over  which 
the  air  in  respiration  wafts  them,  descend  into  the 
stomach ;  arrived  there,  they  cannot  be  readily 
expelled,  as  from  the  lungs,  by  the  alternate  ex- 
pulsion of  air,  and  the  envelopement  of  the  halitus, 
which  is  incessantly  discharged  ;  but  adhering  to 
the  coat  of  the  stomach,  and  acting  like  a  large 
dose  of  opium,  or  other  violent  stimulants,  they 
speedily  render  the  intestines  costive,  thereby 
preclude  their  passage  down,  and  then  proceed  to 
execute  the  remainder  of  their  pernicious  work. 

Upon  the  whole,  it  results,  that  yellow  fever  is 
not  only  the  offspring  of  a  deleterious  poison,  but 
that  this  poison  is  ordinarily  received  into  the  sto- 
mach ;  that  the  great  vitality  and  extensive  asso- 
ciations of  this  viscus  sympathetically  induce  dis- 


68  Observations  on  Yellow  Fever. 

order  in  many  other  vital  parts  of  the  system , 
that  the  delicacy  of  texture  and  the  irritability  of 
the  stomach,  combined  with  the  activity  of  the 
poison,  lead  to  the  inflammation,  or  other  more 
summary  processes,  by  which  its  organization  is 
so  rapidly  broken  down ;  and  that,  therefore,  the 
yellow  fever,  being  thus  primarily  and  essentially 
a  disease  of  the  alimentary  canal,  and  chiefly  of  the 
stomach,  may,  perhaps,  be  distinguished  from  the 
Asiatic  plague,  besides  the  differences  of  climate, 
&c.  by  the  various  modes  in  which  the  miasmata 
are  received  into  the  body  ;  those  of  the  former 
being  less  admissible  by  the  skin  and  more  readily 
miscible  with  saliva,  and  those  of  the  latter  being 
just  the  reverse.  The  few  exceptions  which  take 
place  in  the  rare  occurrence  of  black  vomiting  in 
the  plague  of  Asia,  and  of  buboes  and  carbuncles 
in  the  yellow  fever,  serve  rather  to  confirm  than 
to  weaken  the  force  of  the  general  observation. 

If  the  opinions  concerning  yellow  fever,  which 
are  here  maintained,  be  well  founded,  it  follows, 
that  the  principal  indications  of  prevention  and 
cure  will  be,  1,  To  arrest  the  entrance  of  mias- 
mata into  any  part  of  the  system,  but  particularly 
into  the  stomach.  2.  As  much  as  possible  to 
dilute,  envelope,  and  carry  speedily  through  the 
alimentary  canal,  all  such  miasmata  as  may  una- 
voidably have  gained  admittance  into  it.  3.  At 
the  first  approach  of  morbid  sensations,  to  evacu- 


Observations  on  Yellow  Fever.  69 

ate,  as  speedily  and  completely  as  possible,  the 
contents  of  the  stomach  and  intestines.  And,  4. 
To  allay  the  violence  of  stimulation,  and,  as  far 
as  possible,  to  guard  against  the  consequences  of 
it.  The  limits  of  this  paper  will  not  allow  a  dis- 
cussion of  all  the  means  suited  to  fulfil  these  indi- 
cations :  a  few  remedies  only  will  be  mentioned, 
and  these  in  a  desultory  manner. 

I.  As  it  is  impossible  to  prevent  the  admission 
of  miasmata  into  the  lungs,  while  we  breathe  air 
impregnated  with  them,  and  as,  when  received  in 
that  manner  alone,  they  are  probably  less  perni- 
cious, our  principal  attention  should  be  directed 
to  the  means  of  excluding  them  from  the  stomach. 
Dr.  Rand,  of  Boston,  in  his  excellent  paper  on 
this  disease,  published  in  the  Medical  Reposito- 
ry,* asserts  that  the  air,  in  certain  parts  of  the 
town,  "  was  so  fully  impregnated  with  contagion, 
as  to  be  very  perceptible  to  the  smell  and  taste ;" 
and  he  adds,  "  exciting  the  same  sensation  in  my 
mouth,  as  a  weak  solution  of  corrosive  sublimate 
of  mercury,  and  very  similar  to  the  smell  and 
taste  of  the  effluvia  from  the  confluent  small-pox, 
just  after  maturation  ;  and  it  constantly  excited  in 
me  a  salivation,  during  my  attendance  upon  the 
sick  in  those  places.  I  ascribed,  in  some  measure, 
my  security  from  the  disease  to  this  effect  upon 
the  salivary  glands."     During  the  pestilence  of 

*  Vol.  I.  442, 


70  Observations  on  Yellow  Fever. 

last  summer  and  autumn,  in  this  city,  I  remarked 
in  myself,  whenever  placed  in  infectious  situations, 
an  incessant  inclination  to  discharge  saliva  by  spit- 
ting ;  but  ascribed  this,  probably  by  mistake,  to 
my  caution  in  avoiding  to  swallow  it  while  im- 
mersed in  bad  air.  A  constant  attention  to  this 
point  cannot  be  too  strongly  enjoined  ;  and,  in 
order  to  increase  the  quantity  of  saliva,  as  well  as 
to  insure  its  discharge  by  spitting,  it  is  always  ad- 
visable, in  infected  places,  to  keep  some  pungent 
aromatic  substance  in  the  mouth.  Rinsing  the 
mouth  and  throat  as  often  as  may  be  convenient, 
and  especially  after  returning  from  suspicious  si- 
tuations, as  well  as  before  eating  and  drinking, 
will  always  be  proper.  Attention  to  frequent  ab- 
lution, and  to  all  the  circumstances  of  personal 
cleanliness,  will,  probably,  afford  sufficient  guard 
against  the  absorption  of  miasmata  from  the  sur- 
face. 

II.  This  indication  is  of  great  importance. 
Water,  the  universal  diluent  and  solvent,  deserves 
to  be  relied  upon  for  this  purpose  to  a  great  extent : 
it  should  be  taken  copiously  and  frequently  :  and 
all  those  articles  of  diet  in  which  it  is  a  predomi- 
nant part  should  be  considered  in  the  same  light. 
An  addition  of  a  small  quantity  of  any  sound  fer- 
mented liquor,  especially  porter  or  cyder,  to  the 
degree  of  rendering  it  more  palatable  and  gently 
stimulant,  will  occasionally  be  useful.     Taking 


Observations  on  Yellow  Fever.  71 

animal  food  in  the  form  of  so  "p,  using  milk  plen- 
tifully, and  moderately  distending  the  stomach 
with  any  of  those  liquid  preparations  of  farinaceous 
substances  and  fruits  which  are  easily  digested, 
will  correspond  to  this  indication.  I  can  scarce- 
ly express  the  degree  of  relief  which  I  often  ex- 
perienced, during  the  prevalence  of  the  last  pesti- 
lential epidemic  in  this  city,  by  the  large  use  of 
these  diluting  and  nutritious  articles  :  they  speed- 
ily removed  a  distressing  sense  of  heat  at  the  sto- 
mach, which  I  could  ascribe  to  nothing  but  the 
presence  of  the  poison  of  pestilence.  Two  ad- 
vantages arise  from  keeping  the  stomach  mode- 
rately filled  by  these  liquid  substances  :  every 
thing  acrid  is  diluted  ;  and  the  absorbents,  fully 
employed  in  taking  up  what  is  bland  and  agreeable, 
will  be  more  likely  to  reject  what  is  unsuitable. 

It  is  remarkable,  that  of  those  persons  who  are 
attacked  with  yellow  fever,  a  great  majority  are 
seized  in  the  night,  or  find  themselves  ill  on 
awaking  in  the  morning.  According  to  Dr. 
Fordyce,  the  reverse  of  this,  and  by  a  very  large 
majority,  is  true  of  the  cases  of  ordinary  fevers.* 
Can  this  circumstance  of  yellow  fever  be  owing, 
in  any  measure  to  the  emptiness  of  the  stomach 
taking  place  in  the  night,  and  the  closer  access  to 
its   coat  thereby  afforded  to  the  pestilential  v'- 

*  Dissertation  on  Simple  Fever,  p.  33. 


72  Observations  on  Yellow  Fever. 

rus  ? — If  this  conjecture  have  any  foundation,  an 
oily  diet  must  be  very  important  as  a  preventive 
of  yellow  fever,  and  especially  when  taken  at 
night,  just  before  going  to  bed ;  as,  for  example, 
a  supper  of  sallad  dressed  with  oil.  A  plentiful 
use  of  butter  must  also  be  advisable  on  the  same 
principle.  If  our  opinion  be  true,  the  same  ad- 
vantage would  result  from  an  oil)7  diet  in  stomachic 
pestilence,  or  yellow  fever,  which  has  been  said 
to  arise  from  the  application  of  oil  to  the  surface 
of  the  body,  in  the  glandular  and  carbuncular  pes- 
tilence of  Asia. 

Mountebanks  and  jugglers,  who  undertake  to 
swallow  poisons  in  public,  in  order  to  astonish  the 
multitude,  and  to  draw  money  from  vulgar  cre- 
dulity, are  always  careful  to  take  these  poisons  on 
a  full  stomach.* 

In  the  advanced  stages  of  yellow  fever,  milk  is 
often  resorted  to  as  the  only  substance  which  can 
then  be  borne  by  the  diseased  stomach.  But 
might  it  not  be  used  habitually,  and  in  large  quan- 
tity, as  a  preventive,  and  also,  in  the  early  part  of 
the  disease,  as  a  means  of  obviating  future  mis- 
chief? Wepfer  found  that  milk,  given  to  animals 
at  the  same  time  with  some  of  the  strongest  vege- 
table poisons,  greatly  diminished  their  force. 


■'•  See  "Wepfer  (Hist.  Cicut.  Aquat.") 


Observations  on  Yellow  Fever.       .      73 

But  of  all  the  means  of  obviating  the  approach 
of  this  disease,  preserving  regularity  in  the  intes- 
tinal discharges  is,  perhaps,  the  most  important. 
And,  indeed,  when  this  is  completely  done,  it  seems 
probable  that  nothing  short  of  the  most  concen- 
trated and  virulent  assault  of  miasmata  will  be  suf- 
ficient to  bring  on  the  disease.  It  cannot  be  too 
deeply  impressed,  that  the  stimulus  of  pestilential 
poison,  especially  at  the  beginning  of  its  operation, 
acts  like  an  excessive  dose  of  opium  and  many 
other  stimulants,  in  arresting  the  intestinal  dis- 
charge, and  thereby  precluding  its  own  exit  from 
the  system. 

III.  But  if  all  preventive  means  prove  ineffec- 
tual, and  symptoms  of  the  disease  be  perceived 
to  approach,  it  then  becomes  greatly  interesting 
to  do  whatever  may  be  expedient  with  the  least 
possible  delay.  As  yellow  fever  is  here  consider- 
ed as  the  stomachic  form  of  pestilence,  produced 
by  a  poison  primarily  acting  upon  that  organ,  it  is 
proper,  in  this  case,  as  in  other  cases  of  poison  re- 
ceived into  the  stomach,  in  the  first  place  to  at- 
tempt the  expulsion  of  it.  This  can  be  best  ac- 
complished by  an  emetic,  which,  given  at  a  proper 
time  of  the  forming  stage,  is  perfectly  safe,  and 
efficacious  beyond  all  other  remedies.  The  dis- 
credit attached  to  this  remedy,  in  yellow  fever,  is 
owing  to  the  postponement  of  it  till  inflammation, 
or  some  higher  affection  of  the  stomach,  had  come 

K 


74  Observations  on  Yellow  Fever. 

on,  which  could  only  be  thereby  aggravated,  and 
rendered  more  speedily  fatal. 

If,  therefore,  during  the  prevalence  of  yellow  fe- 
ver, a  person  be  affected  with  any  disorder  of  the 
stomach,  head-ach.  or  pains  of  the  back  or  limbs, 
with  chilliness  or  flushing  of  the  face,  and  es- 
pecially if  such  feelings  shall  have  been  preceded 
by  an  interruption  of  intestinal  evacuation,  white- 
ness of  the  tongue,  &c.  he  will  judge  wisely  to 
take  an  emetic*  without  a  moment's  delay,  and, 

*  In  the  works  of  Frederick,  the  late  king  of  Prussia  (vol. 
ii.  p.  229.)  we  find  the  following  attestation  of  the  efficacy 
of  emetics. 

"  But  the  ravages  of  war  were  unequal  to  the  ravages 
which  epidemical  disease  made  in  the  hospitals.  The  disease 
we  speak  of  was  a  species  of  inflammatory  fever,  accom- 
panied with  all  the  symptoms  of  the  plague.  The  sick  be- 
came delirious  on  the  day  they  were  attacked.  Carbuncles 
appeared  on  the  neck,  and  under  the  arm-pits.  Whether 
they  were  or  were  not  bled,  it  was  the  same  :  death  carried 
off  all  those,  without  distinction,  who  were  attacked  by  this 
malady;  the  venom  of  which  was  so  \irulent,  its  progress  so 
rapid,  and  its  effects  so  prompt,  that  the  patient,  in  three  days, 
was  in  the  grave.  Resort  was  ineffectually  had  to  every 
kind  of  remedy.  At  length  emetics  were  employed,  and  suc- 
ceeded, f     Three  grains  were  dissolved  in  a  measure  of  wa- 

f  On  cut  recours  a  Vemeiujue.  By  this  phrase  the  royal 
author  probably  means  some  preparation  of  antimonj'. 
[Note  of  the  English  Transcriber. 

[For  a  reference  to  this  quotation,  I  am  indebted  to  Mr.  J. 
W.  Watkins,  of  the  Seneca  Lalce.] 


Observations  on  Yellow  Fever.  75' 

as  soon  as  the  operation  of  that  is  completed,  to 
procure  a  speedy  and  perfect  unloading  of  the  in- 
testines. The  choice  of  cathartics  deserves  atten- 
tion. Such  as  operate  expeditiously  and  power- 
fully will  the  sooner  discharge  the  miasmata  ad- 
hering to  the  intestines,  and  pent  up  by  costive- 
ness.  Extraordinary  virtues  have  been  ascribed 
to  castor  oil,  and  probably  with  reason  :  its  demul- 
cent and  enveloping,  as  well  as  cathartic  power, 
must  be  important,  by  guarding  the  alimentary 
canal  from  the  attack  of  a  corrosive  poison.  Many 
of  the  neutral  salts  deserve  great  commendation. 
The  tartrite  of  soda  (Rochelle  salt,)  the  phosphate 
of  soda,  and  the  tartrite  of  potash  (soluble  tartar,) 
are  well  adapted  to  this  purpose ;  and  they  must 
be  especially  invaluable  whenever  the  infectious 
matter  of  pestilence  is  constituted  with  such  a  pro- 
portion of  the  principle  of  acidity  as  to  become 
actually  acid.J     Injections  may  do  much  to  pro- 


ter :  the  sick  were  made  to  drink  till  the  dose  began  to  op- 
erate ;  and  this  was  found  to  be  a  sovereign  specific  against 
the  disease  :  for  after  it  was  brought  into  use  scarcely  three 
out  of  a  hundred  died.  The  causes  of  the  disease,  no  doubt, 
were  perspiration  impeded  by  cold,  and  indigestion  occasion- 
ed by  bad  food.  Powerful  evacuations  only  were  found  ef- 
fectual." 

\  See  Dr.  Mitchill's  paper  on  soda,  Med-  Rep.  vol.  ji, 
p.  274,  3d  edition. 


76  Observations  on  Yellow  Fever. 

cure  a  speedy  solution  of  costiveness,  particularly 
when  they  consist  of  so  large  a  bulk  of  water,  with 
a  quantity  of  mild  oil  and  muriate  of  soda  (com- 
mon salt,)  as  will  effect  the  mechanical  dilatation 
of  the  large  intestines.  For  this  purpose  they 
should  be  administered  by  a  large  syringe,  with 
some  force,  and  in  a  continued  stream,  till  the 
distention  excite  uneasiness.  In  some  instances, 
the  quantity  has  been  carried  to  the  extent  of 
two  gallons  with  advantage.  In  marshy  countries 
it  has  been  frequently  observed,  that  remittent 
fevers  and  dysenteries  often  interchange  their 
forms  ;  one  always  suspending  the  other.  In  the 
West-Indies  it  has  been  proposed  to  use,  by  in- 
jection, a  solution  of  the  muriate  of  mercury  (cor- 
rosive sublimate,)  in  order  to  impregnate  the  sys- 
tem with  that  remedy.  Might  not  a  solution  of 
this  or  some  other  active  stimulant  be  injected 
into  the  rectum,  in  order  to  excite  an  artificial  te- 
nesmus and  dysentery — a  safer  disease  than  yellow 
fever — for  the  purpose  of  diverting,  by  continuity 
of  membrane,  the  morbid  action  from  the  stomach? 

IV.  The  means  of  fulfilling  this  indication  have 
already  been  so  much  the  subject  of  discussion, 
that  it  will  be  less  necessary  now  to  dwell  upon 
them.  It  is  obvious  that,  when  the  disease  as- 
sumes the  tone  of  active  inflammation,  blood-let- 
ting will  stand  first  on  the  list  of  remedies  to  be 
employed  to  diminish  its  violence.     It  is  admit- 


Observations  on  Yellow  Fever.  77 

ted,  at  the  same  time,  that  the  use  of  this  evacu- 
ation, especially  in  the  more  malignant  and  pros- 
trating  forms  of  the  disease,  will  require  the  great- 
est caution  and  discernment.  But,  to  deny  alto- 
gether the  admissibility  of  blood-letting  in  a  state 
of  such  violent  inflammation  as  the  yellow  fever 
often  exhibits,  and  where  dissection  shows,  in 
cases  where  it  had  been  omitted,  such  extensive 
effusions  of  blood  and  serum  in  the  lungs,  brain, 
and  other  important  viscera,  is,  in  my  judgment, 
to  oppose  some  of  the  most  established  maxims 
in  the  practice  of  medicine.  It  is  true,  indeed, 
where  a  large  dose  of  miasmata  has  been  received 
into  the  system,  and  remains,  for  some  time,  un- 
diluted and  undiminished,  that  every  hope  of  re- 
lief from  this  remedy  will  ultimately  fail. 

The  efficacy  of  mercury  deservedly  places  it 
high  in  the  list  of  remedies  adapted  to  this  indica- 
tion ;  but  as  the  operation  of  it  is  very  complex, 
and  little  understood,  it  would  be  improper  at  pres- 
ent, to  undertake  the  discussion. 

Blisters  are  entitled  to  great  confidence,  es- 
pecially when  applied  to  the  epigastric  region  for 
the  purpose  of  relieving  the  local  disease  of  the 
stomach  ;  but  they  are  generally  resorted  to  nt  too 
late  a  period.  They  seem  to  be  better  adapted  to 
obviate  the  incipient  affection  of  the  stomach,  than 
to  restore  its  exhausted  powers,  or  to  arrest  the 


78  Observations  on  Yellow  Fever. 

decomposition  which  takes  place  in  the  advanced 
stages. 

Cold  water,  applied  to  the  surface  of  the  body 
by  affusion  or  immersion,  is  one  of  the  most  pow- 
erful means  of  diminishing  excessive  action  of  the 
sanguiferous  system  in  fevers.  Dr.  Currie,  of 
Liverpool,  has  treated  this  subject  with  so  much 
ability  and  precision,  that  its  importance  in  the 
scale  of  remedies  is  likely  to  be  greatly  augmented. 
He  is  very  sanguine  of  its  efficacy  in  yellow  fever, 
and  accordingly  recommends  it,  in  strong  terms, 
to  practitioners  of  medicine  in  the  West-Indies 
and  in  America.  In  the  more  violent  cases  he  pre- 
fers immersion  to  affusion,  as  being  more  com- 
petent to  produce  that  great  reduction  of  action 
which  the  exigency  of  the  occasion  requires  ;  but 
in  this  mode  of  application,  it  is  obvious,  the  re- 
medy will  demand  the  utmost  attention.  It  is  so 
impossible,  in  a  few  words,  to  do  justice  to  his 
directions  for  the  management  of  water,  in  its  ex- 
ternal and  internal  use,  that  the  reader  must  be 
referred  to  the  work  itself  for  more  complete  in- 
formation. As  a  means  of  carrying  off  heat,  and 
of  dissolving  the  catenation  of  morbid  actions 
which  forms  the  essence  of  fever,  this  remedy  can 
have  no  superior. 

The  advanced  stages  of  yellow  fever,  like  those 
of  other  malignant  diseases,  often  present  a  con- 


Observations  on  Yellow  Fever.  79 

dition  of  the  system  not  yet  sufficiently  investi- 
gated, and  which  it  is  a  great  desideratum  to  be 
able  successfully  to  treat.  This  condition,  besides 
the  usual  circumstances  of  debility  and  exhaustion, 
is  distinguished  by  duskiness  of  the  skin,  often  by 
livid  or  black  maculae,  by  a  darker  colour  and 
thinner  consistence  of  the  blood,  by  tendency  to 
hasmorrhagy,  and  by  other  signs  of  the  scorbutic 
diathesis.  How  far  the  irritability  of  the  system 
may  immediately  depend  on  the  quantity  of  oxy- 
genous matter  present  in  it,  or  how  far  the  stimu- 
lus of  pestilential  poison  may  be  apt  peculiarly  to 
consume  and  dissipate  such  matter,  I  shall  not,  at 
present,  undertake  to  inquire.  But  as  this  state 
of  the  body,  in  yellow  fever,  so  remarkably  resem- 
bles the  appearances  of  scurvy,  and  as  a  large  sup- 
ply of  oxygen  is  found  to  be  so  efficacious  in  the 
latter  disease,  it  is  surely  proceeding  on  fair  anal- 
ogy to  extend  the  remedies  of  scurvy  to  the  state 
of  the  disease  now  in  question.  The  efficacy  of 
the  native  acids  of  vegetables,  and  particularly  the 
citric,  has  been  long  established  in  the  treatment 
of  scurvy.  Besides  the  usual  modes  of  adminis- 
tering these  acids  by  conveying  them  into  the 
stomach,  perhaps  some  preparations  of  them  might 
usefully  be  introduced  by  way  of  injection.  And 
if  to  this  be  added  the  respiration  of  air,  charged 
with  an  additional  quantity  of  oxygenous  gas,  the 
force  of  this  remedy  will  probably  be  carried  to 
the  utmost  degree. 


REPORT 


ON 


THE  MALIGNANT  DISEASE, 

WHICH  PREVAILED  IN  THE  CITY  OF  NEW-YORK, 

IN  THE  AUTUMN  OF  1805: 

ADDRESSED  TO  THE  GOVERNOR 

OF   THE 

STATE  OF  NEW-YORK. 


TO 

JAMES  RUSH,  M.  D. 

PHILADELPHIA. 


Dear  Sir, 

I  ADDRESS  You  as  the  representative  of 
your  illustrious  Father.  The  close  and  endearing 
friendship  which  subsisted  between  Him  and  the 
Author  of  the  following  Report,  will  appear  from 
the  biographical  Sketch  prefixed  to  the  present 
volume.  Nor  can  I  ever  forget  the  paternal  at- 
tentions with  which,  for  a  number  of  years,  He  was 
pleased  to  honour  me.  Allow  me  to  offer  to 
You,  and,  through  you,  to  His  revered  Memory, 
the  best  expression  of  respect  and  gratitude  in  my 
power,  by  presenting  you  with  a  memoir  on  a 
subject  peculiarly  interesting  to  American  Phy- 
sicians, and,  perhaps,  the  most  valuable  produc- 
tion of  its  Author's  pen. 

Accept,  Sir,  my  best  wishes  for  your  welfare 
and  happiness.     You  bear  an  honoured  name. 
May  it  receive  from  your  career  new  lustre  ! 
I  am,  dear  Sir,  most  respectfully, 
Your  friend  and  obedient  servant, 

THE  EDITOR. 

Nnv-York,  August  10th,  1813. 


THE  following  Report  was  received  by  the 
Public,  on  its  first  appearance,  with  peculiar  tes- 
timonies of  respect  and  approbation.  Soon  after 
its  publication,  it  was  reprinted  in  Great  Britain  ; 
translated  into  the  French  and  German  languages; 
and  inserted,  at  large,  by  M.  Dumeril,  in  his 
Report  on  the  Spanish  Epidemic  of  1804,  ad- 
dressed to  the  Emperor. 


ftT*  "DISTANT  readers  will  be  belter  enabled  to  understand 
this  Report  by  adverting  to  the  following  particulars.  Tlie  city 
of  New-York  lies  in  N.  lat.  40  42  8 ;  W.  long.  74  9  45 ;  at 
the  confluence  of  the  river  Hudson  and  Long-Island  sound,  or 
the  East  river  ;  and  on  the  southern  and  narrow  extremity  of 
Manhattan-Island,  which  is  about  1 5  miles  in  length,  and  from 
one  to  two  in  breadth.  The  site  of  tlie  city,  as  it  originally 
stood,  was  very  irregular,  being  broken  into  hills  and  declivi- 
ties, and  indented  with  small  rivulets  or  creeks,  skirted  with 
marsh.  Many  of  the  hills  are  levelled  ;  but  the  marshy  grounds, 
though  covered  with  houses  and  pavement,  are  still  low  and 
moist.  The  city  is  about  27  miles  from  the  ocean,  and  is  wash- 
ed on  both  sides  with  water  of  great  depth,  whose  current  is  very 
rapid,  whose  tide  ebbs  and  flows  about  6  feet,  and  whichis  nearly 
as  salt  as  that  of  the  neighbouring  sea.  On  both  sides  of  tlie  ci- 
ty considerable  encroachments  have  been  made  on  the  water  by 
artificial  ground,  the.  whole  extent  of  which  may  be  computed  at 
not  less  than  132  acres.  Of  (his,  90  acres  lie  along  the  East 
rivrr,  and  42  along  the  Hudson.  The  portion  of  it  on  the  East 
river  forms  that  part  of  the  city  where  malignant  fevers  have 
always  first  become  epidemic  and  chi'fiy  prevailed.  The  wharves 
and  docks  are  constructed  of  logs  and  loose  stones.  Ml  the  fresh 
water  used  by  the  inhabitants  is  procured  from  wells  within  the 
city,  and  is  now  become  extremely  impure.  The  population  of 
New-York  may  be  estimated  (A.  D.  1305)  at  about  80,000-. 


(     87     ) 


REPORT,  &c 


New-York,  Jan.  12th,  1806. 
Sir, 

1  HE  Malignant  Disease  which  prevailed  in 
this  city,  for  a  considerable  part  of  last  autumn, 
having  ceased  about  the  beginning  of  November, 
it  becomes  my  duty  to  lay  before  your  Excellency 
such  an  account  of  it  as  my  official  situation  has 
enabled  me  to  collect. 

I  undertake  this  task  with  the  more  readiness, 
and  shall  examine  the  subject  with  the  more  atten- 
tion, as  this  disease  has  lately  acquired  great  addi- 
tional importance  from  the  frequency  of  its  recur- 
rence, the  extent  of  its  ravages,  and  the  new  and 
alarming  points  of  view  in  which  it  is  now  con- 
sidered by  the  nations  of  Europe.  The  embar- 
rassments of  our  commerce  on  this  account,  in 
foreign  ports,  have  been  increasing  for  several 
years;  they  are  already  become  oppressively  great ; 


88  Report  on  Yellow  Fever. 

they  are  likely  hereafter  to  become  still  greater ; 
and  nothing  but  a  thorough  investigation  of  the 
subject,  and  the  adoption  of  a  wise  and  mature 
system  of  measures,  will  be  sufficient  to  ascertain 
and  set  in  operation  any  adequate  means  of  relief. 

In  former  seasons,  it  has  been  usual  to  observe 
sporadic  cases  of  this  disease  for  several  weeks  be- 
fore the  commencement  of  the  epidemic.  This 
was  remarkably  verified  in  the  late  season ;  and 
such  cases  deserve  the  more  attention  as  they  fur- 
nish the  best  means  of  calculating  the  probability 
of  approaching  pestilence.  Accordingly,  one  case 
of  a  decidedly  malignant  character  was  observed 
in  the  month  of  June  ;  several  took  place  in  Jul)  ; 
a  still  greater  number  in  August ;  and  at  the  be- 
ginning of  September,  they  had  become  so  nume- 
rous as  to  ascertain  the  existence  of  the  epidemic. 
Throughout  September  and  October,  the  disease 
continued  to  prevail  with  more  or  less  severity, 
according  to  the  fluctuating  states  of  the  weather  ; 
but  towards  the  close  of  the  latter  month,  the  cold- 
ness of  the  season  had  evidently  checked  its  pro- 
gress ;  and  at  the  beginning  of  November,  the 
city  was  nearly  restored  to  its  usual  health. 

During  the  early  period  of  the  epidemic,  nearly 
all  the  cases  took  place  on  the  eastern  side  of  the 
city,  in  Front,  Water,  and  Pearl-streets,  and  prin- 
cipally below  Burling- slip.     They  afterwards  be- 


Report  on  Yellow  Fever.  89 

came  more  generally  diffused.  About  the  20th 
of  September,  they  began  to  prevail  near  the  North 
River.*  On  the  whole,  the  lo*v. grounds  on  the 
margin  of  the  two  rivers  certainly  produced  a  chief 
part  of  the  cases.  The  number  of  deaths  of  the 
disease  in  the  city,  amounted  to  about  200  ;  those 
at  Bellevue  Hospital  to  52 ;  and  those  at  the  Ma- 
rine Hospital,  sent  from  the  city,  to  28.  The  num- 
ber of  cases  of  malignant  fever  reported  to  the 
Board  of  Health  amounted  to  about  600.  It  is 
proper,  likewise,  in  estimating  the  extent  of  the 
epidemic,  to  notice  an  unascertained  number, 
probably  about  40,  who  after  their  flight  from  the 
city,  died  in  various  parts  of  the  country. 

The  source  of  this  disease  forms  a  most  inte- 
resting subject  of  inquiry  ;  on  the  success  of  which 
must  depend  all  rational  and  adequate  means  of 
preventing  and  eradicating  the  evil.  After  a  long 
and  careful  investigation  of  the  subject,  I  cannot 
hesitate  to  conclude,  that  a  pernicious  exhalation 

*  A  similar  extension  of  the  disease,  in  the  epidemic  of 
1803,  was  ascribed  by  many  to  the  removal  of  shipping 
from  the  East  to  the  North  river.  As  no  such  removal  to 
that  part  of  the  city  took  place  in  the  late  season,  it  is  ne- 
cessary to  explain  the  fact  in  some  other  way.  This  becomes 
very  easy,  when  it  is  recollected  that  the  made  ground  on 
the  North  river  is  much  less  extensive,  and  the*  material? 
composing  it  much  less  foul  and  corrupt,  than  that  on  the 
East  river.  The  miasmata  come  to  maturity  on  the  one  side 
two  or  three  weeks  sooner  than  on  the  other. 

M 


$0  Report  on  Yellow  Fever. 

or  vapour  floating  in  the  atmosphere,  is  the  pri- 
mary and  essential  cause  of  this  disease.  In  order 
to  produce  this  vapour,  it  is  necessary  that  there 
should  be  a  concurrence  of  heat,  moisture,  and  a 
quantity  of  decaying  animal  and  vegetable  matter. 
It  is  therefore  exhaled  by  heat  from  low  and  moist 
grounds,  overspread  with  the  corrupting  offals  of 
animal  and  vegetable  substances,  from  such  sub- 
stances collected  in  large  masses,  or  from  any 
place  where  the  process  of  putrefaction  is  going 
on  to  considerable  extent.  This  exhalation  like- 
wise abounds  more  in  some  situations  than  in  oth- 
ers. It  is  more  frequently  and  copiously  produ- 
ced, and  more  highly  concentrated,  in  warm  and 
tropical  countries  than  in  high  latitudes  and  fro- 
zen regions.  It  prevails  and  exerts  its  pernicious 
influence  peculiarly  in  certain  climates,  seasons, 
and  local  situations.  It  is  generated  more  in  sum- 
mer, and  operates  more  powerfully  in  autumn  than 
in  the  other  seasons  of  the  year  ;  and  it  is  uni- 
formly more  frequent  and  virulent  in  sea-port 
towns,  in  situations  along  sea-coasts,  in  plains,  and 
near  rivers,  lakes,  marshes  and  swamps,  or  where  - 
ever  stagnant  waters  are  found,  than  in  the  inte- 
rior, high  and  mountainous  districts  of  the  coun- 
try. It  is  undoubtedly  one  of  the  most  universal 
eauses  of  disease  in  nature.  However  diversified 
in  quantity  or  virulence  by  local  circumstances, 
or  by  varieties  of  climate,  season,  or  the  condition 
©f  society,  its  effects  in  one  degree  or  another  are 


Report  on  Yellow  Fever.  91 

nearly  co-extensive  with  the  habitable  parts  of  the 
globe. 

While  the  noxious  exhalation  just  described, 
when  existing  in  a  high  degree  of  virulence,  is 
considered  as  forming  the  primary  and  essential 
cause  of  our  disease  ;  it  is  proper,  in  order  to  be 
well  understood,  to  notice  the  operation  of  certain 
secondary  or  exciting  causes.  These  are  exposure 
to  heat,  fatigue,  cold,  intemperance,  fear,  anxiety, 
&c.  some  of  which  are,  in  general,  immediately 
instrumental  in  bringing  on  the  disease  in  persons 
predisposed  to  it  by  the  agency  of  the  atmospheric 
poison.  The  noxiousness  of  this  poison,  by  avoid- 
ing exciting  causes,  may  often  be  long  borne 
without  falling  into  illness  ;  and  hence  the  ope- 
ration of  exciting  causes  in  suddenly  producing 
the  disease  is  often  so  striking  as  to  lead  many 
entirely  to  overlook  the  effect  of  the  principal  agent* 

The  sources  of  pernicious  exhalation  in  this 
city  are  unhappily  very  numerous  and  difficult  to 
correct.  Some  of  them  are  evils  of  such  magni- 
tude and  extent,  that  it  requires  resolution  to  con- 
sider them,  and  not  to  relinquish,  in  despair,  the 
work  of  reformation.  The  mode  of  constructing 
our  wharves  and  slips  would  almost  induce  the  be- 
lief that  they  had  been  designed  for  repositories 
of  filth  and  nurseries  of  disease.  The  made  ground 
on  the  East  river  is  pregnant  with  almost  annual 


92  Report  on  Yellow  Fever. 

pestilence  ;  it  is  now  become  enormously  exten- 
sive ;  it  was  originally  composed  of  the  most  cor- 
rupt materials  ;  from  its  relation  to  the  river,  and 
the  condition  of  the  wharves  and  slips,  it  must 
constantly  remain  moist  ;  from  its  surface  being 
nearly  level,  it  receives  and  retains  the  collected 
filth  washed  down  from  the  higher  grounds  ;  and 
besides  all  this,  the  offensive  and  putrid  matter, 
which  a  crowded  population  must  necessarily  de- 
posit, and  which  already  underlays  a  great  pro- 
portion of  this  part  of  the  city,  incessantly  aug- 
ments the  mass  of  corruption.  Can  it  possibly 
excite  surprise,  that  the  scorching  heat  of  sum- 
mer, operating  on  the  complicated  pollution  of  this 
ground,  formed  of  an  aggregate  of  nuisances,  and 
still  the  receptacle  of  numberless  others,  should 
exhale  poison  and  death  into  the  atmosphere  which 
stagnates  over  its  surface  ? 

As  the  materials  of  putrefaction  and  the  degrees 
of  heat,  in  a  large  city,  greatly  exceed  what  is 
found  in  the  adjacent  country  ;  so  the  diseases 
arising  under  such  circumstances  must  be  propor- 
tionably  more  malignant.  The  pestilential  fevers 
of  our  city  differ  only  in  grade  from  the  bilious 
and  remittent  fevers  of  the  country.  They  prevail 
in  the  same  climates  ;  they  come  on  at  the  same 
season  of  the  year ;  they  are  chiefly  disposed  to 
attack  persons  of  the  same  constitution  ;  they  com- 
mit their  ravages  on  the  same  organs  of  the  body. 


Report  on  Yellow  Fever.  93 

and  produce  symptoms  differing  only  in  degree  ; 
and  they  decline  and  disappear  at  the  same  season, 
and  under  the  same  circumstances.  In  the  city  we 
often  see  in  the  same  family  and  under  equal  cir- 
cumstances of  exposure,  the  malignant  forms  of 
pestilence  and  the  mild  forms  of  remittent  fever  ; 
and  in  the  country,  while  the  great  mass  of  cases 
are  usually  mild,  we  occasionally  meet  with  some 
which  exhibit  the  violent  attack,  the  intense  ma- 
lignity and  the  rapid  dissolution,  which  more  fre 
quently  mark  the  pestilential  fevers  of  the  city. 

Besides  the  points  of  analogy  just  mentioned, 
there  is  another  equally  or  perhaps  more  remark- 
able. The  remittent  fever  of  the  country,  and 
the  malignant  fevers  (denominated  yellow)  of  our 
cities,  have  a  similar  irregularity  which  generally 
characterizes  them,  and  leads  strongly  to  the  in- 
ference of  the  similarity  of  their  origin.  In  the 
districts  of  the  country  where  remittent  fevers 
prevail,  and  in  the  cities  which  produce  malig- 
nant fevers,  we  find  these  diseases,  in  seasons  ap- 
parently similar,  and  even  in  the  same  season,  of- 
ten exhibiting  a  singular  local  unsteadiness  in  their 
appearance,  extent  and  violence.  In  the  operation 
of  the  causes  which  produce  them,  there  is  some- 
thing remarkably  contingent  and  desultory.  Re- 
mittent fevers  will  prevail  sometimes  in  one  dis- 
trict of  a  low  country  and  sometimes  in  another  ; 
while  the  whole  extent  of  these  different  districts 


94  Report  on  Yellow  Fever. 

seems  to  be  equally  liable  to  the  disease,  and  no 
adequate  cause  can  be  assigned  for  the  visitation 
of  the  one,  and  the  escape  of  the  other.  In  like 
manner,  some  of  our  cities  are  invaded  by  pesti- 
lence, in  unfavourable  seasons  ;  while  others,  ap- 
parently just  as  liable  to  be  invaded,  escape. 

For  these  reasons,  as  v.rell  as  many  others  which 
my  limits  will  not  allow  me  to  state,  I  conclude 
that  our  late  epidemic,  and  all  the  preceding  simi- 
lar ones,  have  been  of  domestic  origin,  and,  of 
course,  nearly  related  to  the  remittent  bilious  fe- 
vers of  the  country. 

From  this  simple  and  consistent  view  of  the 
subject,  the  attention  of  some  has  been  unfortu- 
nately drawn  aside  by  the  mistaken  opinions  of  the 
Importation  of  the  disease  from  abroad^  and  the 
propagation  of  it  by  contagion. 

I.  As  the  question  of  contagion,  in  this  disease, 
is  important  and  fundamental,  and  as  the  affirma- 
tive has  been  asserted  with  much  confidence,  it 
becomes  necessary  to  consider  this  point  with 
great  attention. 

But,  before  proceeding  to  oiler  reasons  in  detail 
against  the  contagiousness  of  yellow  fever,  it  is 
proper  to  premise  some  general  observations  on 
the  subject. 


Report  on  Yellow  Fever.  95' 

A  contagious  disease  is  distinguished  from  all 
others  by  the  property  of  generating  or  secreting 
a  matter,  which,  applied  by  contact,  or  inhaled 
with  the  air,  by  near  approach  to  the  sick,  or  to 
inanimate  substances  charged  with  their  effluvia, 
successively  reproduces  the  same  disease.     As 
this  contagious  matter  is  secreted  by  a  morbid  ac- 
tion of  vessels,  or  a  peculiar  process  of  the  dis- 
ease, forming  a  specific  and  essential  part  of  its 
character,  it  must  always  be  generated  when  such 
disease  exists  ;  and  being  generated,  and  then  du- 
ly applied  or  inhaled,  its  action  is  altogether  in- 
dependent of  external  circumstances,  such  as  the 
state  of  the  air,  &c.  and  must  always  take  effect, 
unless  there  be  something  in  the  condition  of  per- 
sons exposed  to  it,  which  renders  them  unsuscep- 
tible of  the  impression.     This  unsusceptibility, 
depending  upon  peculiar  and  unusual  circumstan- 
ces, (except  in  the  diseases  which  attack  the  same 
person  but  once,)  must  of  course  be  extremely 
rare.     The  small-pox  affords  an  example  of  this 
operation  of  contagion.     If  forty  persons,  who 
have  never  undergone  small-pox,  be  closely  ex- 
posed to  the  effluvia  of  a  number  of  patients  ly- 
ing ill  of  that  disease  in  the  ward  of  a  small-pox 
hospital,  thirty- nine  certainly,  and  probably  the 
whole  number,  will  be  infected.     This  is  an  ex- 
ample of  a  contagious  distemper.    The  contagious 
matter  is  the  constant  and  universal  product  of 
the  disease  ;  and  when  produced,  it  generally  re- 


96  Report  on  Yellow  Fever. 

produces  itself  in  such  as  receive  it ;  provided  they 
have  not  been  (in  the  case  of  small-pox)  previous- 
ly subjected  to  its  action.  The  principle  of  un- 
susceptibility  cannot  reside  in  the  surrounding  air, 
but  is  to  be  sought  for  in  the  condition  of  the  body 
that  resists  the  contagion.  There  are  no  facts  to 
prove  that  pure  atmospheric  air  is  a  neutralizer 
or  destroyer  of  contagion  ;  every  day  presents  in- 
stances of  the  reverse  ;  and  when  diffused  through 
an  extensive  space,  air  renders  it  harmless,  not  by 
decomposing,  but  by  diluting  and  dissipating  it. 
On  the  other  hand,  none  of  the  truly  contagious 
diseases  derive  any  additional  force  from  impure 
air  ;  for  the  greater  contagiousness  of  confined  air 
in  cases  of  this  sort,  arises  merely  from  the  con- 
centration of  a  greater  quantity  of  contagious  mat- 
ter within  a  small  space.  The  application  of  these 
principles  to  the  subject  in  question  will  presently 
be  seen. 

It  is  proper  likewise  to  premise,  that  the  attack 
of  many  persons  in  the  same  neighbourhood,  or 
even  of  whole  families,  by  a  reigning  disease,  af- 
fords no  proof  of  contagion  ;*  for  the  intermittent 

*  In  the  course  of  the  autumn,  about  five  years  ago, 
ninety-eight  out  of  a  hundred  of  the  labourers  employed 
at  the  Onondaga  Salt-Works,  in  this  State,  were  attacked 
with  bilious  fever.  The  two  who  escaped,  probably  owed 
their  exemption  to  extensive  ulcers  with  which  they  happen- 
ed, at  that  time,  to  be  affected.     That  situation  is  unusual- 


Report  on  Yellow  Fever.  97 

and  remittent  bilious  fevers  of  the  country,  which 
undoubtedly  are  not  propagated  by  contagion,  of- 
ten  attack  families  and  neighbourhoods  so  gene- 
rally as  scarcely  to  leave  healthy  persons  in  suffi- 
cient number  to  attend  the  sick.  The  want  of 
due  discrimination  between  the  effects  of  an  im- 
pure atmosphere  and  of  contagion,  is  one  of  the 
most  lamentable  deficiencies  in  the  history  of 
diseases.* 

The  agency  of  contagion  in  the  propagation  of 
our  malignant  disease  is  rejected  for  the  following 
reasons. 

ly  sickly  in  the  summer  and  autumn  ;  and  a  large  propor- 
tion of  the  cases  of  fever  which  occur  there,  become  malig- 
nant and  fatal.  By  the  death  of  several  persons,  within  a 
few  years,  who  held  the  office  of  Superintendant  of  the  Works, 
and  who  fell  victims  to  this  malignant  fever  in  close  suc- 
cession, that  station  is  now  justly  regarded  by  the  people  of 
the  neighbouring  districts,  as  extremely  hazardous. 

*  Some  epidemic  diseases,  such  as  small-pox,  syphilis,  &.c. 
are  considered,  by  universal  consent^  as  contagious  ;  others, 
such  as  intermittent  and  remittent  fevers,  &.c.  are  considered 
as  non-contagious.  It  becomes,  therefore,  extremely  inte- 
resting to  ascertain  the  criteria  by  which  this  discrimination 
among  epidemic  distempers  may  be  clearly  and  promptly 
made.  The  want  of  precision  on  this  point  has  produced 
much  collision  of  opinion  and  much  absurdity  of  conduct 
among  physicians  and  others.  The  most  obvious  criterion, 
and  that  which  is  most  generally  recognized  by  the  common 
sense  of  mankind,  is  the  effect  of  personal  intercourse  be- 

N 


98  Report  on  Yellow  Fever. 

1.  No  relation  is  observed  between  the  source 
of  the  pretended  contagion,  and  the  spreading  of 
the  disease  to  individuals  or  families  ;  nor  was 
there  ever  any  successful  attempt  progressively 
to  trace  the  propagation  of  it  to  any  number  of  per- 
sons, from  the  first  case,  or  from  any  single  point 
of  infection.  If  the  first  ten  or  twenty  cases,  which 
occur  in  any  season,  be  strictly  scrutinized,  most 
of  them  are  found,  in  their  origin,  to  be  distinct 
and  independent  of  one  another.  Instead  of  per- 
vading families,  or  creeping  slowly  from  one  neigh- 
bourhood to  another,  in  the  track  of  infection,  as 
is  invariably  the  case  with  contagious  distempers, 
this  disease  is  often  found  scattered  at  distant  and 
unconnected  points,  and  cases  start  up  singly  in 
situations  where  contagion  could  neither  be  traced 
nor  suspected. f     The  proportion  of  single  cases 

tween  the  sick  and  the  well.  Where  a  disease  is  truly  corv- 
fagious,  this  intercourse  cannot  fail  to  disclose  the  danger, 
which  was  long  ago  correctly  stated  in  poetical  language  : 

obsuntque  anctoribus  artes : 

"  Quo  propior  quisque  est,  servitque  fidelius  aegro, 

"In partem  lethi  citius  venit." 

Olid.  Mctamorph.  lib.  7. 

f  Not  only  the  dispersion  of  cases  is  adverse  to  the  doc- 
trine of  contagion  ;  but  the  appearance  of  them  in  groups  ia 
some  instances  is  altogether  as  much  so.  Many  of  the  most 
judicious  of  our  citizens  were  convinced  of  the  origination 
of  the  disease  from  domestic  filth  in  the  year  1798,  by  the 
following  occurrence.     Between  twenty  and  thirty  persons. 


Report  on  Yelloxv  Fever.  99 

in  the  midst  of  families  is  always  great  ;  and  the 
instances  of  any  large  proportion  of  families  being 
attacked  were  comparatively  very  rare  in  our  late 
epidemic.  It  appears  from  the  records  of  this  epi- 
demic, that  there  were  thirty-one  streets  of  the 
city,  most  of  which  continued  to  be  filled  with  in- 
habitants, through  the  whole  season,  in  which  only 
a  single  case  in  each  occurred  ;  and  in  the  mass 
of  six  hundred  cases  reported  to  the  Board  of 
Health,  there  were  only  thirty-five  houses  in  which 
more  than  a  single  case  was  found.  If  the  num- 
ber of  deaths  should  be  supposed  to  afford  better 
ground  of  calculation,  it  will  be  found  that  there 
were  forty  streets,  and  those  generally  crowded 
throughout  the  season,  in  which  only  one  death  in 
each  took  place  ;  not  more  than  three  died  in  any 
one  house,  of  which  there  were  only  two  instances  ; 
and,  during  the  whole  epidemic,  there  were  only 
twelve  instances  of  two  persons  dying  in  one 
house.*    The  great  mass  of  persons  attacked  with 

at  the  commencement  of  that  destructive  epidemic,  in  a  small 
neighbourhood  at  the  lower  end  of  John-street,  were  sudden- 
ly seized  with  the  disease  in  one  night,  in  consequence  of  8 
blast  of  putrid  and  most  offensive  exhalations  from  the  sew- 
er of  Burling-shp.  The  persons  attacked  were  only  such  as 
lived  directly  to  the  leeward  of  this  blast  from  the  sewer  ; 
while  many  others,  close  in  the  vicinity,  but  not  exposed  to 
this  current,  entirely  escaped. 

*  From  these  reports  to  the  Board  of  Health,  it  results 
that  upwards  of  five  hundred,  out  of  six  hundred  cases  of 


100  Report  on  Yellow  Fever. 

the  disease,  consisted  of  such  as  never  had  ap- 
proached the  sick,  or  any  other  assignable  source 
of  contagion  ;  and,  on  the  contrary,  as  will  pres- 
ently appear,  great  numbers  were  exposed  to  close 
intercourse  with  the  sick,  without  injury. 

In  order  to  explain  this  scattered,  remote  and 
unconnected  occurrence  of  cases,  the  advocates 
of  contagion  are  obliged  to  resort  to  the  extrava- 
gant supposition  of  the  contagion  being  diffused 
through  an  extensive  range  of  atmosphere,  or,  to 
use  their  own  singular  phrase,  of  an  inoculation  of 
the  atmosphere  by  the  effluvia  of  the  sick,   or  of 
the  infected  cloathing  or  bedding  which  were  sup- 
posed originally  to  have  introduced  the  contagion. 
It  is  scarcely  necessary  to  observe,  that  this  is  a 
new  and  unheard  of  doctrine,  utterly  unknown  and 
repugnant  to  all  the  principles  and  laws  of  the 
communication   of  contagion,  which  have  been 
sanctioned  by  the  experience  of  ages,  and  entirely 
subversive  of  all  the  hopes  the  contagionists  them- 
selves can  repose  on  a  separation  of  the  sick  from 
the  well,  or  on  the  most  rigid  regulations  of  quar- 
antine.    This   doctrine    is  likewise  inconsistent 
with  itself.     If  contagion  from  a  single  source  can 

malignant  fever  which  occurred,  were  single  in  the  respec- 
tive families  ;  and  that  more  than  three-fourths  of  the  deaths 
which  took  place  in  the  city,  were  likewise  single  in  the  res- 
pective families  in  which  they  occurred. 


Report  on  Yellow  Fever.  101 

extend  itself  so  far,  what  would  become  of  the  in- 
habitants of  the  city  generally,  when,  in  the  pro- 
gress of  the  epidemic,  cases  are  so  immensely 
multiplied,  and  the  disease  so  extremely  diffused  ? 
If  this  contagion  can  exercise  such  a  destructive 
activity  at  a  distance,  after  being  so  much  diluted 
in  the  air,  what  must  be  the  effect  of  approaching 
near  to  the  source  ?  If  a  contagion  really  existed, 
capable  of  retaining  its  virulence,  after  such  ex- 
tensive diffusion  in  the  atmosphere,  it  would  bid 
defiance  to  all  the  barriers  of  quarantine,  be  un- 
controllable by  human  means,  and  finally  would 
depopulate  the  world.  Another  inconsistency  is 
equally  glaring.  If  this  effluvium  from  a  sick 
body,  or  from  foul  cloathing  and  bedding,  can  be 
supposed  to  vitiate  the  air  to  such  a  distance 
around,  it  must,  after  such  extensive  diffusion,  be- 
come light  and  fugitive,  and  liable  to  be  blown 
away  by  the  first  breeze.  But,  how  shall  we  ex- 
plain the  fact,  that  this  same  space  of  air,  after  the 
inhabitants  are  fled,  the  sick  removed,  and  the 
houses  shut  up,  continues,  till  a  change  of  season, 
to  be  permanently  noxious  ?  Nothing  can  ac- 
count for  this  local,  stationary  and  inexhaustible 
poison,  but  the  exhalations  from  the  masses  of 
filth  and  corruption  overspreading  a  large  area  of 
ground,  forming  a  vast  hot-bed  of  putrefaction, 
incessantly  teeming  with  miasmata,  and  thereby, 
in  despite  of  currents  of  air,  loading  with  the  seeds 
of  disease  every  successive  portion  of  atmosphere 


102  Report  on  Yellow  Fever. 

that   sweeps    or  stagnates    over   the   pestilential 
surface. 


2.  The  pretended  contagion  is  admitted  to  pro- 
duce no  effect  in  our  climate,  except  in  particular 
situations,  and  at  a  particular  season  of  the  year, 
when  an  impure  and  noxious  atmosphere,  which 
ought  to  be  considered  as  a  sufficient  cause,  is  ac- 
knowledged to  exist.  But  to  consider  a  disease 
as  contagious,  which  at  the  same  time  exhibits  no 
appearance  of  that  quality  but  in  certain  climates, 
in  such  climates  only  in  certain  places,  at  such 
places  only  at  certain  seasons,  and  even  at  such 
seasons  only  after  a  particular  degree  of  heat  and 
moisture,  is  undoubtedly  to  lose  sight  of  all  the 
established  properties  and  laws  of  contagion. 

3.  It  is  admitted  that  the  disease  does  not  spread 
when  the  sick  are  removed  from  the  impure  air  in 
which  it  was  contracted.  By  breathing  this  im- 
pure air,  without  exposure  to  the  effluvia  of  the 
sick,  persons  are  every  day  attacked  ;  while,  on 
the  contrary,  without  breathing  it,  however  ex- 
posed to  such  effluvia,  no  person  is  attacked. 
The  conclusion,  therefore,  is  irresistible,  that  the 
impure  air  is  the  cause. 

4.  No  communication  of  the  disease  was  ever 
observed  in  yellow  fever  hospitals,  situated  at  a 
small  distance  from  the  cities  to  which  they  be- 


Report  on  Yellow  Fever.  103 

long.  No  exception  to  this  has  ever  occurred  in 
any  of  the  numerous  seasons  of  this  pestilence  at 
our  hospital  at  Bellevue,  the  Marine  Hospital  at 
Staten  Island,*  that  of  Philadelphia,  or  any  other 
in  the  United  States  ;  provided  the  malignant  air 
of  the  city  had  been  avoided.  The  force  of  this 
fact  seems  never  to  have  been  duly  considered  or 
appreciated.  The  numerous  retinue  of  medical 
attendants,  nurses,  washerwomen,  servants,  &c. 
which  belong  to  a  hospital,  must  be  known  to 
every  body.  How  greatly  they  are  all  exposed 
to  contagion,  if  it  could  be  supposed  to  exist  in 
this  case,  is  equally  known.  The  most  malignant 
degrees  of  the  disease  are  constantly  found  in 
these  institutions.  The  exposure  of  physicians 
and  their  assistants  is  well  understood.  The  du- 
ty of  the  nurses  leads  to  an  incessant  and  unre- 
served intercourse  with  the  sick.  They  pass  the 
greater  part  of  their  time,  and  sleep  in  the  apart- 
ments of  the  sick,  the  dying  and  the  dead.f     In 

*  The  two  pretended  cases  of  contagion  at  the  Marine 
Hospital  on  Staten  Island,  one  in  the  year  1^99  and  the  other 
in  1800,  were  evidently  fevers  produced  by  the  poison  of 
typhus,  modified  by  the  season.  Nature  is  too  simple  and 
uniform  in  her  operations  to  constitute  a  disease  contagious, 
and  yet  only  so  once  in  a  thousand  instances, 

f  The  nurses  at  Bellevue  Hospital  became  so  entirely 
free  from  all  apprehensions  of  the  contagiousness  of  this  dis- 
ease, that  they  often  slept  on  the  same  bed  with  the  sick ; 
and  it  happened  more  than  once,  in  the  course  of  the  season, 


104  Report  on  Yellow  Fever. 

lifting,  undressing,  dressing,  administering  reme- 
dies, and  many  other  modes  of  assistance,  they  are 
very  often  in  actual  contact,  and  commonly  within  a 
small  distance  of  the  patients.  They  receive  and 
carry  away  all  excrementitious  discharges.  Several 
persons  are  employed  in  washing  the  foul  clothes 
and  bedding  of  the  sick  and  the  dead.  Not  only 
all  these  have  invariably  escaped  the  disease,  but 
likewise  all  the  persons  occupied  in  the  removal  of 
the  sick  from  the  city  to  the  hospital,  who  in  this 
service  went  without  reserve  into  the  most  pesti- 
lential quarters  of  the  town,  entered  the  most  filthy 
apartments,  and  lifted  the  sick  into  their  carriages 
dressed  in  their  foulest  clothes,  and  sinking  under 
the  worst  degrees  of  the  disease.* 

In  order  to  account  for  these  facts,  the  advocates 
of  contagion  contend  that  its  activity  is  confined 
to  impure  air,  and  that  by  this  alone  it  can  be  con- 
ducted to  the  objects  of  its  attack.     Our  hospital 

that  a  nurse,  overcome  with  fatigue  and  want  of  sleep, 
threw  herself  in  the  night,  for  a  little  repose,  on  the  bed  of 
a  dying  patient,  and  remained  there  asleep  till  the  patient 
was  dead,  and  it  became  necessary  to  remove  the  corpse. 

*  In  order  to  account  for  the  escape  of  these  person?, 
which  is  indeed  wonderful,  it  is  proper  to  state  that  they  all 
resided  during  the  season  at  the  Aims-House,  an  elevated 
and  healthy  part  of  the  city,  and  consequently  were  only 
for  a  short  period,  at  any  one  time,  immersed  in  the  noxious 
atmosphere. 


Report  on  Yellow  Fever.  105 

at  Bellevue,  however,  is  not  so  constructed  as  to 
allow  the  supposition  of  great  purity  of  the  air ; 
and  indeed  the  state  of  the  land-air  in  the  months 
of  August,  September  and  October,  cannot  be 
considered  as  pure,  in  any  part  of  our  country. 
But  admitting  the  highest  possible  purity  of  air  in 
these  hospitals,  the  operation  of  contagion,  if  it  ex- 
isted there,  could  not  by  such  means  be  avoided. 
When  the  naked  hands  of  physicians  and  nurses 
are  in  contact  with  the  skin  of  the  patient,  scorch- 
ed with  febrile  heat,  or  bedewed  with  the  matter 
of  perspiration,  how  can  pure  air  be  interposed  to 
arrest  the  passage  of  contagion  ?  When  they  in- 
hale, as  they  often  do,  the  breath  and  effluvia  of 
the  sick,  no  man  can  doubt  that  such  air  is  suffi- 
ciently impure  to  be  the  conductor  of  contagion, 
if  it  really  existed.  In  all  contagious  diseases, 
contact  and  immediate  inhalation  of  the  effluvia 
and  breath  of  the  sick,  are  supposed  to  constitute 
the  greatest  possible  exposure  ;  and  in  such  cases, 
it  is  plain,  the  interposition  of  air,  pure  or  impure, 
must  be  equally  unavailing  to  arrest  the  evil.  Yet 
in  these  hospitals,  persons  not  only  escape  this 
danger,  but  none  was  ever  known  to  be  infected 
by  it.J 

\  In  the  epidemic  of  the  year  1798,  seven  persons  died  of 
Yellow  Fever  in  our  Aims-House.  It  was  ascertained  that 
they  had  taken  the  disease  in  consequence  of  going  oj  id 
breathing  the  atmospheric  poison  diffused  through  the  more 


106  Report  on  Yellow  Fever. 

5.  The  extinction  of  the  disease  by  cold  weather, 
is  an  insuperable  objection  to  the  doctrine  of  its 
propagation  by  contagion.  That  the  disease  in 
reality  depends  upon  an  atmospheric  poison,  ap- 
pears from  the  fact,  that  all  the  means  which  ope- 
rate to  arrest  and  destroy  it,  such  as  cold,  heavy 
rains  and  high  winds,  are  merely  atmospheric  a- 
gents.  The  healthy  temperature  of  the  human 
body  is  the  same  in  all  climates  and  seasons  ;  and 
febrile  heat  is  not  less  in  winter  than  summer. 
Consequently,  the  morbid  process  by  which  the 
matter  of  contagion  is  generated,  is  under  no  con- 
trol from  atmospheric  temperature.  Hot  climates 
and  seasons  are  universally  held  to  be  unfavour- 
able to  the  spreading  of  contagion.  The  reason 
is  obvious.  In  warm  weather,  the  doors  and 
windows  of  the  apartments  of  the  sick  are  kept 
open,  and  ventilation  is  carried  to  the  highest  de- 
gree. At  this  season,  the  effluvia  of  the  body, 
whether  in  health  or  disease,  are  sooner  dissipated, 
and,  of  course,  can  less  readily  adhere  to  clothing, 
bedding,  walls,  furniture,  &c.  so  as  to  be  retained, 
and  become  noxious.  In  conformity  to  this,  ty- 
phus, which  is  propagated  by  a  poison  produced 
in  the  clothing,  bedding,  furniture,  &.c.  of  persons 
living  in  filthy  and  crowded  apartments,  generally 


contaminated  districts  of  the  city.  Although  the  house  then 
contained  about  800  persons,  no  communication  of  contagion 
took  place. 


Report  on  Yellow  Fever.  107 

prevails  and  spreads  much  more  in  winter,  when 
such  apartments  are  deprived  of  ventilation.  On 
the  contrary,  yellow  fever,  arising  from  a  delete- 
rious principle  floating  in  the  atmosphere,  and 
produced  by  the  operation  of  solar  heat  upon  ve- 
getable and  animal  filth,  ceases  to  prevail  soon 
after  this  heat  is  reduced  so  low  that  it  can  no 
longer  exhale  a  sufficient  quantity  of  the  miasmata 
of  putrefaction.  But  if  this  disease  depended 
upon  contagion,  instead  of  disappearing  at  the  ac- 
cession of  cold  weather,  when  houses  are  more 
closely  shut  up,  it  would  be  then  more  certainly 
communicated,  and  more  widely  destructive. 

6.  Yellow  fever  does  not  prevail  in  countries, 
where  the  heat  is  not  sufficient  to  exhale  the  mi- 
asmata of  foul  grounds,  and  other  corrupting  mat- 
ters, in  the  requisite  quantity  and  virulence.  We 
hear  nothing  of  this  disease  in  Great  Britain,  Ire- 
land, or  France  ;  though  it  is  well  known  that 
persons  ill  of  it,  and  shipping  in  which  it  has  re- 
cently prevailed,  very  frequently  arrive  in  their 
ports.  The  boarding-houses  in  the  sea-port  towns 
of  these  countries,  in  which  seamen  arriving  from 
the  West- Indies  are  generally  lodged,  are  known 
to  be  often  extremely  filthy  and  filled  with  impure 
air ;  as  appears  from  the  prevalence  and  ravages 
of  typhus  ;  yet  this  impure  air  in  those  countries 
cannot  conduct  the  contagion  of  yellow  fever. 


108  Report  on  Yellow  Fever. 

7.  Many  persons,  who  had  contracted  the  dis- 
ease in  New- York,  died  of  it  at  Boston,  Albany, 
and  other  cities  at  a  distance ;  many  likewise  at 
Greenwich,  Brooklyn,  and  other  villages  in  the 
neighbourhood.  In  no  instance  did  these  victims 
of  the  epidemic  communicate  contagion.  In  all 
these  places,  the  air  at  that  season  must  have  been 
very  impure ;  at  Albany  and  Brooklyn,  violent 
remittent  fevers  were  at  the  same  time  extremely 
prevalent ;  and  yet  this  impurity  of  the  air  did 
not  serve  as  a  conductor  of  contagion. 

8.  Among  the  early  cases  of  this  disease,  in  the 
late  season,  which  were,  as  usual,  most  virulent, 
very  striking  examples  of  its  non-contagiousness 
were  displayed  in  some  of  the  most  crowded  quar- 
ters of  the  city.  In  the  beginning  of  September, 
a  considerable  number  of  sick,  who  had  taken 
the  disease  on  the  eastern  side  of  the  city,  were 
removed  to  the  western  side,  where  they  died 
with  the  most  pestilential  symptoms.  In  a  house 
in  Cedar-street,  where  two  patients  expired  under 
the  worst  symptoms  of  this  description,  the  *  beds 

*  It  is  proper-to  observe  that,  since  the  first  publication  of 
this  letter,  a  contradiction  of  the  statement  concerning  the 
beds  has  been  received  from  one  person,  and  a  confirmation 
of  it  from  another.  That  particular  circumstance  is,  how- 
ever, immaterial ;  as  it  is  admitted  on  all  hands  that  no  con- 
tagion arose  from  either  of  these  malignant  cases. 


Report  on  Yellow  Fever.  109 

of  the  deceased,  in  a  very  few  hours  after  their 
death,  were  occupied  by  the  survivors  of  the 
family.  Yet  in  none  of  these  numerous  instances 
was  any  contagion  communicated. 

9.  The  universal  exemption  of  the  physicians 
of  New- York,  amounting  at  least  to  50  or  60  per- 
sons, from  the  late  disease,  is  also  irreconcilable 
with  the  doctrine  of  its  contagiousness.  I  have 
not  heard  of  any  physician  in  Philadelphia,  New- 
Haven,  Providence  or  Norfolk,  suffering  illness 
from  their  late  epidemics.  It  is  known  that  phy- 
sicians neither  use  nor  possess  antidotes.  Their 
exposure  to  the  breath,  effluvia  and  contact  of  the 
sick,  was  almost  incessant  from  morning  till  night. 
They  employed  no  precaution  of  dress  or  cover- 
ing, no  fumigation,  no  means  of  destroying,  neu- 
tralizing or  obviating,  in  any  manner,  the  effluvia 
of  their  patients.  The  dissection  of  bodies  dead 
of  Yellow  Fever,  if  contagion  had  existed,  would 
also  have  formed  another  source  of  danger.  Many 
of  the  physicians  of  this  city  were  frequently  en- 
gaged in  this  mode  of  investigating  the  disease, 
and  minutely  examined  bodies  in  a  very  advanced 
state  of  putridity.  The  more  happy  escape  of 
physicians  in  the  late  than  in  former  epidemics,  is 
to  be  attributed  (under  the  protection  of  Divine 
Providence)  to  their  having  secured  a  residence  in 
the  higher  and  safer  parts  of  the  town,  and  to  the 
comparative  infrequency  of  their  visits  to  the  dis- 


110  Report  on  Yellow  Fever. 

tricts  of  envenomed  atmosphere ;  owing  to  the 
early  desertion  of  these  districts  by  the  chief  part 
of  the  inhabitants.  It  is  understood,  at  the  same 
time,  that  our  physicians,  in  their  confidence  of 
the  non-contagiousness  of  the  disease,  generally 
passed  more- time  in  the  apartments  of  the  sick, 
and  were  in  the  habit  of  making  a  more  deliberate 
and  minute  examination  of  the  cases  which  fell 
under  their  care,  than  in  preceding  epidemics.* 

10.  The  failure  of  every  attempt  to  arrest  the 
progress  of  the  disease,  by  the  separation  of  the 
sick  from  the  well,  is  also  incompatible  with  the 
doctrine  of  contagion.  Besides  the  numerous  in- 
effectual attempts  in  this  city,  the  utmost  endea- 
vours were  used,  with  the  same  result,  by  the 
Board  of  Health  of  Philadelphia,  whose  members 
had  been  purposely  selected  for  this  object,  from 
those  who  embraced  the  opinion  of  the  importa- 
tion and  contagiousness  of  the  disease.  It  would 
be  fortunate,  indeed,  for  the  purpose  of  arresting 
Yellow  Fever,  if  its  progress  depended  upon  con- 

*  The  exemption  of  the  nurses  from  disease,  who  attended 
the  sick  in  the  city,  was  also  very  remarkable.  Upwards  of 
sixty  persons  were  employed,  by  the  Board  of  Health,  to  per- 
form this  duty.  Only  four  of  these  died  ;  two  others  only  were 
sick  and  recovered.  And  it  appears,  upon  inquiry,  that  such 
as  died  or  were  sick,  had  been  stationed  in  the  parts  of  the 
city  where  the  atmosphere  Avas  known  to  be  most  highly 
charged  with  tiie  miasmata  of  putrefaction. 


Report  on  Yellow  Fever.  Ill 

tagion.  This  appears  from  the  example  of  the 
small-pox,  a  disease  whose  contagion  is  more  ac- 
tive, steady  and  permanent  than  any  other  in  the 
world.  By  a  system  of  quarantine,  extremely 
simple  and  very  little  burthensome,  this  distemper 
is  excluded,  or,  if  introduced,  immediately  arrest- 
ed and  banished,  in  Boston  and  other  cities  of 
New- England,  where  its  admission  and  circula- 
tion are  prohibited  by  law. 

11.  The  inconsistency  and  contradiction  which 
constantly  attend  the  application  of  the  doctrine  of 
contagion  in  this  disease,  make  it  altogether  in- 
admissible. To  explain  one  set.  of  facts,  it  must 
infinitely  transcend  the  contagiousness  of  small- 
pox ;  to  suit  another,  it  must  sink  infinitely  in  the 
opposite  direction.  On  some  occasions,  it  is 
more  subtle,  penetrating  and  rapid  than  the  elec- 
tric fluid  ;  on  others,  more  sluggish  and  dormant 
than  the  grossest  matter.  Contrary  to  all  other 
noxious  substances,  it  is  often  more  destructive 
at  a  distance,  than  near  to  its  source  ;  for  at  one 
time,  it  cannot  reach  a  single  individual  among  a 
great  number  surrounding  the  bed  of  the  patient, 
and  in  frequent  contact  with  his  person,  while  at 
another,  it  must  strike  at  the  distance  of  several 
hundred  feet.*      The    noxiousness   of   the 

*  While  it  is  admitted  that  contagion  cannot  operate  in 
Yellow  Fever  Hospitals,  and  while  this  inactivity  of  it  is  as- 


112  Report  on  Yellow  Fever. 

MIASMATA  OF  PUTREFACTION,  EXHALED  BY 
HEAT  AND  FLOATING  IN  THE  ATMOSPHERE, 
EXPLAINS  ALL  THESE  FACTS,  AND  RECON- 
CILES   ALL     THESE     CONTRADICTIONS. 

If  it  were  possible  to  add  any  thing  to  the  evi- 
dence of  these  irresistible  facts,  I  might  subjoin, 
that  Yellow  Fever  cannot  be  considered  as  a  con- 
tagious disease  ; — Because,  unlike  all  other  con- 
tagious diseases,  it  has  no  specific  character,  no 
definite  course  or  duration,  and  no  appropriate, 
essential  or  pathognomonic  symptom  ; — Because, 
the  supposed  contagion  rarely  operates  singly,  and 
in  general  depends  upon  the  co-operation  of  ex- 
citing causes  ; — and  finally,  Because,  the  miasma- 
ta which  produce  this  disease  are  more  or  less 
noxious  as  they  are  more  or  less  concentrated,  a 
property  which  does  not  belong  to  the  specific 
poisons  of  small-pox,  syphilis,  &c. 

Under  the  conviction  of  these  facts,  I  am  com- 
pelled to  conclude  that  our  malignant  disease  is 

cribed  to  the  absence  of  impure  air ;  it  is,  at  the  same  time, 
gravely  asserted  by  some,  that  a  person  going  on  board  of  a 
vessel,  lying  in  a  situation  where  the  air  is  much  more  pure 
than  it  can  possibly  be  at  a  hospital,  even  though  there  exist 
no  sickness  on  board  of  such  vessel,  may  still  derive  conta- 
gion from  it,  and  experience  all  the  active  and  malignant 
operation  of  such  contagion,  notwithstanding  this  purity  of 
the  surrounding  atmosphere. 


Report  on  Yellow  Fever.  113 

the  effect  of  a  noxious  exhalation  floating  in  the 
atmosphere,  and  that  it  is   absolutely   and 

UNIVERSALLY     NON-CONTAGIOUS. 


For  the  correctness  of  the  facts  on  which  this 
conclusion  is  founded,  I  appeal  to  my  fellow  prac- 
titioners and  fellow-citizens,  who  have  been  wit- 
nesses of  the  disease.  For  the  application  of  these 
facts  in  the  deduction  of  principles  and  opinions, 
I  appeal  to  the  judgment  of  physicians  in  every 
quarter  of  the  world,  where  Medicine  is  cultivated 
as  a  regular  science.  And,  especially,  I  would 
offer  this  appeal  to  the  liberal  and  enlightened 
physicians  of  Europe,  who  are  sincerely  devoted 
to  the  cause  of  truth  and  professional  improve- 
ment ;  who,  on  this  subject,  have  heretofore  re- 
ceived much  incorrect  information  ;  and  who,  as 
soon  as  they  become  convinced  of  the  real  state  of 
the  question,  will,  I  am  confident,  exert  the  influ- 
ence they  so  justly  possess,  in  procuring  from 
their  respective  governments  an  abolition  of  the 
oppressive  and  useless  restrictions  of  quarantine, 
which  have  been  recently  imposed  on  American 
commerce. 

II.  The  second  mistake  concerning:  this  ma- 
Kgnaiit  disease,  which  has  been  impress*  d  on  the 
minds  of  some  of  our  ckizens,  is  that  of  itc  im- 
portation frum  abroad,  and  chiefly  from  the  West- 

p 


114  Report  on  Yellow  Fever. 

Indies.     This  opinion  is  rejected  for  the  following 
reasons  : 

1.  The  non-contagiousness  of  the  disease,  if  ad- 
mitted, must  entirely  destroy  the  belief  of  its  in- 
troduction from  abroad.  It  is  impossible  to  con- 
ceive that  it  can  be  conveyed  across  the  ocean,  and 
propagated  in  the  cities  of  the  United  States,  un- 
less it  possess  the  power  of  successively  re- pro- 
ducing itself  by  communication  of  contagion  from 
one  person  to  another. 

2.  If  the  alleged  importation  were  possible  in 
any  case,  it  might  happen  at  any  season  of  the 
year.  In  this  active  sea-port,  shipping  from  the 
West- Indies  are  very  frequently  arriving  at  all 
seasons  ;  and  it  is  known  that  yellow  fever  may 
be  found  in  those  islands  at  any  period  of  the  year, 
when  they  are  visited  by  strangers  from  the  higher 
latitudes  :  yet  the  pretended  importation  is  always 
confined  to  that  period  of  the  summer  and  autumn, 
when  local  and  domestic  causes,  sufficient  to  pro- 
duce the  disease,  are  known  to  exist. 

3.  If  yellow  fever  could  be  introduced  from 
abroad,  it  is  impossible  to  explain  its  non-appear- 
ance in  our  sea-ports  for  a  long  series  of  years, 
when  no  means  were  used  to  secure  its  exclusion. 
For  more  than  fifty  years  preceding  1795,  no  im- 
portation of  the  disease  into  this  city  was  suspect- 


Report  on  Yellow  Fever.  115 

ed ;  and  it  is  indeed  uncertain  whether,  before  that 
year,  the  opinion  of  its  importation  at  any  period 
of  the  eighteenth  century,  had  attracted  much  at- 
tention. The  advocates  of  importation  generally 
assert,  that  periods  of  war  in  the  West- Indies  are 
most  apt  to  occasion  its  introduction  into  this 
country.  Yet  we  hear  nothing  of  its  being  brought 
to  this  port  during  the  war  of  1756,  or  that  of  the 
American  Revolution.  In  the  former  of  these 
wars,  the  mortality  attending  the  successful  ex- 
peditions against  Martinique,  Guadaloupe  and  the 
Havanna,  was  almost  incredible.  Only  a  very 
small  part  of  the  victorious  troops  were  alive  three 
months  after  their  conquests.  Equally  fatal  were 
the  malignant  fevers  of  the  West- Indies  in  the 
war  of  the  American  Revolution.  Dr.  Hunter* 
informs  us,  that  of  5,000  troops  who  took  posses- 
sion of  St.  Lucie,  scarcely  a  man  of  the  original 
number  remained  at  the  end  of  one  year ;  although 
the  sword  of  the  enemy  had  destroyed  an  incon- 
siderable amount.  The  mortality  continued  as 
great  in  the  subsequent  years.  From  the  1st  of 
May  1780,  to  the  1st  of  May  1781,  the  number 
of  dead  was  equal  to  the  average  strength  of  the 
garrison  during  the  year.  Of  the  troops  sent 
from  Jamaica  upon  the  expedition  against  Fort 
St.  Juan,  scarcely  a  man  ever  returned.  During 
this  period,  the  intercourse  between  the  West- In- 

*  Observations  on  the  Disease?  of  the  Army  in  Jamaica. 


116  Report  on  Yellow  Fever. 

dies  and  the  port  of  New- York,  must  have  been 
extremely  frequent.  Doctor  Blane  *  states,  that 
in  the  course  of  the  war  of  our  Revolution,  nearly 
18,000  sick  were  landed  at  New- York  from  the 
British  fleets  ;  that  1 1  sail  of  the  line  arrived  here 
early  in  September,  1780,  from  the  West- Indies  ; 
that  26  sail  of  the  line  arrived  here  at  the  same 
season  in  1782,  likewise  from  the  West- Indies  ; 
and  that  from  each  of  these  fleets,  a  great  number 
of  sick,  afflicted  with  malignant  fevers,  were  sent 
to  the  hospitals  at  this  place.  It  is  also  known 
that  a  similar  fleet  arrived  here  in  the  beginning 
of  the  autumn  of  the  year  1781.  During  all  this 
period,  notwithstanding  the  ravages  of  yellow  fe- 
ver in  the  West- Indies,  and  the  conveyance  of  so 
many  sick  to  this  port,  we  hear  nothing  of  the  im- 
portation of  the  disease.  And  yet,  at  that  time, 
no  quarantine-regulations  existed. 

The  contingencies  by  which  yellow  fever  might 
have  been  imported,  through  the  medium  of  com- 
mercial shipping  or  of  naval  and  military  expedi- 
tions, if  such  importation  were  possible,  must  very 
often  have  occurred  in  a  sea-port  like  this,  where 
such  extensive  communication  has  been  so  long 
maintained  with  the  West- Indies.  A  more  fre- 
quent introduction  of  the  disease,  therefore,  ac- 
cording to  the  doctrine  of  importation,  as  now  held, 
must  have  been  inevitable.     But  as  this  did  not 

*  Observations  ou  the  Diseases  of  Seamen. 


Report  on  Yellow  Fever.  117 

take  place  for  such  a  length  of  time,  and  under 
circumstances  so  likely  to  produce  it,  we  are 
warranted  in  the  conclusion  that  importation  is 
impossible. 

On  the  contrary,  as  the  history  of  pestilential 
epidemics  in  all  ages  and  countries  demonstrates 
that  they  are  subject  to  frequent  revolutions,  as  to 
the  periods  and  places  of  their  prevalence,  the 
variety  of  their  symptoms  and  the  degrees  of  their 
malignity  ;  it  is  much  more  easy  to  account  for 
changes  in  such  diseases,  as  they  locally  or  period- 
ically occur,  than  for  any  great  diversity  or  fluc- 
tuation in  the  circumstances  or  contingencies, 
which  determine  their  importation  from  abroad. 

4.  No  importation  of  this  disease,  so  as  to  be- 
come epidemic,  was  ever  known  in  any  port  of 
Great  Britain,  Ireland  or  France.  The  vast  amount 
of  shipping,  as  was  observed  before,  which  arrive 
at  those  ports  from  the  West-Indies,  is  well 
known  ;  and,  that  they  often  arrive  in  a  very  sick- 
ly condition,  is  equally  known.  The  filth  and  im- 
pure air  of  those  ports  are  admitted  on  all  hands, 
and  the  effects  of  them  are  experienced  in  the  des- 
tructive fevers  of  a  different  description  which 
frequently  prevail ;  and  yet,  for  want  of  the  atmos- 
pheric heat  and  other  local  circumstances  requisite 
in  the  generation  of  yellow  fever,  they  are  happily 
strangers  to  its  epidemic  prevalence. 


118  Report  on  Yellow  Fever. 

5.  The  appearance  of  yellow  fever  in  many  of 
the  interior  parts  of  the  country,  inaccessible  to 
foreign  contagion,  confirms  the  opinion  of  its  do- 
mestic origin,  while  it  entirely  invalidates  that  of 
its  importation.  There  is  not  a  State  in  the  Union, 
which  has  not  afforded  evidence  of  the  production 
of  the  disease,  in  situations  where  importation  was 
impracticable.  In  the  course  of  the  late  season,  a 
malignant  fever,  in  all  essential  points  the  same  as 
our  yellow  fever,  prevailed  in  many  parts  of  this 
State,  and  caused  more  mortality,  in  proportion 
to  the  population  of  the  district,  than  took  place 
in  this  city.  There  can  be  no  reasonable  doubt, 
that  the  disease  called  the  Lake  Fever,  in  the  in- 
terior of  this  State,  possesses  all  the  essential  at- 
tributes of  the  yellow  fever. 

6.  A  comparison  of  the  summer  and  autumn  of 
the  year  1804,  with  the  corresponding  seasons  in 
1805,  will  go  far  to  shew  the  dependence  of  our 
malignant  epidemics  on  the  condition  of  the  at- 
mosphere, and,  of  course,  to  overthrow  the  doc- 
trine of  importation.  The  summer  of  1804,  was 
mild  and  cool,  beyond  former  example,  on  all  the 
Atlantic  coast  of  the  United  States,  lying  to  the 
northward  of  the  Carolinas.  In  South-Carolina 
and  Georgia,  the  heat  was  unusually  great.  All 
the  Atlantic  cities  north  of  the  Carolinas,  without 
exception,  entirely  escaped  the  epidemic  ;  where- 
as at  Charleston  and  in  some  parts  of  Georgia,  it 


Report  on  Yellow  Fever.  119 

prevailed  with  great  mortality.  On  the  contrary, 
the  late  summer  was  remarkable  for  the  duration 
as  well  as  the  intensity  of  heat,  along  the  whole  of 
our  coast.  And  the  consequence  was,  not  only 
that  nearly  all  the  Atlantic  cities  were  visited  with 
pestilence,  but,  what  was  still  more  surprising, 
that  in  several  of  them  it  made  its  appearance  with- 
in forty-eight  hours,  or  nearly,  of  the  same  time ; 
an  occurrence  which  cannot  be  explained  on  the 
contingency  of  importation,  and  is  only  to  be  satis- 
factorily accounted  for  from  the  state  of  the  atmos- 
phere. 

7.  The  occurrence  of  similar  diseases  in  other 
parts  of  the  world,  under  similar  circumstances, 
where  contagion  introduced  from  abroad  cannot 
possibly  be  suspected,  is  also  adverse  to  the  doc- 
trine of  importation.  In  making  the  circuit  of  the 
globe,  on  the  parallels  of  latitude  nearly  or  exactly 
corresponding  with  ours,  we  pass  over  countries 
which,  from  the  earliest  records  of  history,  have 
been  frequently  visited  with  the  ravages  of  this 
disease.  Spain  and  Italy  afford  striking  examples. 
The  city  of  Rome,  in  particular,  though  its  eleva- 
ted situation  is  generally  salubrious,  is  annoyed 
by  a  marshy  spot  at  the  feet  of  two  of  its  hills, 
along  the  margin  of  the  Tiber,  which  has  been 
sickly  and  pestilential  from  the  origin  of  the  city. 
While  the  streets  on  the  hills,  like  Broadway  and 
other  high  grounds  in  this  city,  enjoy  a  salubrious 


120  Report  on  Yellow  Fever. 

air,  the  spot  of  marsh  just  mentioned,  together 
with  a  small  extent  of  made-ground,  (for  the  mad- 
ness of  making  ground  has  raged  at  Rome  as  well 
as  at  New- York,*)  corresponding  with  our  marshy 
districts  and  vastly  more  extended  space  of  made- 
ground,  along  the  margin  of  the  East-River,  has 
produced,  from  time  immemorial,  malignant  and 
mortal  epidemics.  And  the  medical  historian  of 
these  facts,  (the  celebrated  B  .glivi)  expresses  his 
astonishment  that  so  small  a  distance,  as  that  inter- 
vening between  the  elevated  and  depressed  por- 
tions of  ground,  should  make  such  a  difference  in 
the  qualities  of  the  air.  As  the  Tiber  is  not  navi- 
gable for  sea- vessels,  the  importation  of  their  pes- 
tilential epidemics  at  Rome  was  never  suggested. 

8.  The  inefficacy  of  all  the  various  modifications 
of  quarantine  hitherto  devised  in  this  country, 
confirms  our  disbelief  of  importation.  In  this 
port,  as  well  as  in  Philadelphia,  a  rigid  system  of 

*  Proofs  of  this  might  be  adduced  from  Lancisi  and  other 
medical  writers  of  Rome.  The  following  lines  are  sufficient 
to  establish  the  fact : 

Hoc,  ubi  nunc  fora  sunt,  udffi  tenuere  paludes ; 

Amne  redundatis  fossa  madebat  aquis. 
Curtius  ille  lacus,  siccas  qui  sustinet  aras, 

Nuncsolida  est  tellus,  sed  lacus  ante  fuit. 
Qua  Velabia  solent  in  Circum  ducere  pompas, 

Nil  prater  salices  cassaque  canna  fuit. 

Ovid.  Fast.  Lib.  VI. 


Report  on  Yellow  Fever.  121 

quarantine  has  been  in  operation  for  many  years  ; 
and  there  is  no  doubt  of  its  having  been  vigilantly 
and  faithfully  executed.  Indeed,  the  experience 
of  quarantine  in  the  United  States  speaks  little  in 
its  favour  ;  for  though,  during  the  last  ten  years* 
it  has  been  scrupulously  enforced  in  several  ports, 
we  have  heard  ten  times  more  of  imported  con- 
tagion and  of  its  ravages,  at  these  very  ports,  du- 
ring that  short  period,  than  for  an  hundred  years 
before,  when  no  quarantine  was  in  existence. 

9.  The  entire  want  of  all  proof,  and  even  of  the 
least  probability,  of  the  introduction  from  abroad 
of  the  germ  of  our  late  epidemic,  gives  the  last 
blow  to  the  doctrine  of  importation.  The  facts 
on  this  subject  have  been  so  clearly  and  minutely 
detailed  by  the  Health  Officer,  that  it  would  be 
superfluous  to  repeat  them  here. 

The  source  of  mistake  on  the  subject  of  impor- 
tation, consists  in  not  distinguishing  a  febrile  poi- 
son generated  by  heat  and  filth  in  a  vessel,  from 
contagion  taken  up  in  a  foreign  port,  and  succes- 
sively communicated  from  one  person  to  another. 
The  construction  of  vessels  disposes  them  to  the 
collection  and  retention  of  filth,  and  renders  clean- 
sing and  ventilation  extremely  difficult.  The 
quality  of  cargoes  and  provisions,  the  inattention 
of  seamen  to  cleanliness,  the  crowded  manner  in 
which  they  often  live,  the  unsuspected  and  inac- 


122  Report  on  Yellow  Fever. 

cessible  situations  in  which  corrupting  substances 
may  lie  concealed,  render  shipping,  independently 
of  the  hazards  of  the  element  on  which  they  move, 
the  most  dangerous  of  all  human  habitations.  It 
is  no  wonder,  therefore,  that  they  should  become 
unhealthy,  when  they  pass  into  warm  latitudes,  or 
lie  in  our  harbour  in  the  hot  season.  In  no  si- 
tuation is  a  malignant  fever  more  apt  to  originate 
than  in  a  ship.  A  vessel  that  never  left  our  port, 
or  that  has  remained  in  it  for  years,  may  become 
foul  and  thereby  generate  and  emit  a  deadly  exha- 
lation. Whether  malignant  fever  arise  from  filth 
ashore  or  on  shipboard,  the  principles  and  pro- 
cess, by  which  the  evil  is  produced,  are  still  the 
same.  On  what  ground  can  a  disease  be  said  to 
be  imported,  which  has  no  other  relation  to  a  for- 
eign country,  than  that  of  being  generated  in  a 
vessel  which  has  lately  visited  that  country  ?  The 
foreign  country,  the  outward  and  homeward  voy- 
age, are  circumstances  of  no  moment  in  deter- 
mining the  origin  and  character  of  the  disease  ;  to 
account  for  this,  we  must  consider  the  filth,  the 
moisture  and  heat,  which,  concurring  to  a  certain 
degree,  are  destructive  to  man  at  all  times,  in  all 
situations  and  under  every  condition.  And  a  fe- 
ver originating  under  such  circumstances,  can  no 
more  be  pronounced  imported,  than  a  fracture  of  a 
limb  happening  at  sea  can  be  called  an  imported 
fracture. 


Report  on  Yellow  Fever.  123 

It  has  been  supposed  by  some,  who  regard  only 
one  aspect  of  the  subject,  that  the  doctrine  of  im- 
portation alone  can  explain  the  more  frequent  re- 
currence of  malignant  epidemics  for  the  last  ten 
years.  But  the  difficulty  still  returns  with  unaba- 
ted force ;  and  it  remains  to  explain,  why  impor- 
tation has  become  so  much  more  frequent  and  easy 
of  late  than  formerly.  If  it  be  thought  impracti- 
cable to  throw  light  on  that  peculiar  constitution 
of  the  air,  which  determines  the  prevalence  of  yel- 
low fever  at  one  time  more  than  another ;  it  is 
equally  impracticable  to  ascertain  the  qualities  of 
the  air  which  produce  malignant  distempers  of  the 
throat,  the  dysentery,  and  other  mortal  epidemics, 
(which  are  undoubtedly  of  domestic  origin)  for 
a  season,  or  for  a  term  of  years,  and  then  allow 
them  to  disappear. 

It  has  been  said,  that  the  belief  of  the  yellow 
fever  originating  in  this  country,  would  be  des- 
tructive to  its  commerce  and  prosperity.  But  if 
the  appeal  must  be  made  to  interest  rather  than 
truth,  let  us  contrast  the  effects  of  the  two  opin- 
ions, as  they  influence  our  intercourse  with  for- 
eign nations.  By  truly  describing  the  disease,  and 
exhibiting  the  proofs  of  its  local  origin  and  non- 
contagiousness,  we  convince  foreign  nations  that 
it  is  a  misfortune  limited  to  ourselves,  that  it  can- 
not endanger  their  safety,  and  that  it  only  claims 
their  sympathy  and  regrets.     By  asserting  the  im- 


124  Report  on  Yellow  Fevef. 

portation  and  contagiousness  of  it,  the  evil  imme- 
diately swells  to  an  indefinite  and  incalculable  ex- 
tent, and  we  alarm  all  nations  with  the  fear  of  its 
being,  in  turn,  exported  to  them.  After  the  ex- 
perience already  gained,  neither  they  nor  we  can 
cherish  any  rational  hope  of  hereafter  excluding 
it,  by  regulations  of  quarantine.  Our  intercourse 
with  the  West-Indies,  and  with  all  other  tropical 
countries,  will  be  daily  extended,  and  if  importa- 
tion were  possible,  the  chances  of  it  will  be  every 
year  progressively  multiplied.  On  the  ground  of 
importation,  unless  trade  be  totally  forsaken,  our 
situation  is  hopeless. 

In  rejecting  the  doctrine  of  importation,  the  be- 
nefits of  quarantine  are  by  no  means  intended  to  be 
undervalued.  The  generation  of  pestilential  dis- 
ease in  foul  vessels  is  undeniable  ;  they  are  cer- 
tainly a  very  frequent  source  of  malignant  sick- 
ness ;  and  all  persons  concerned  in  shipping  are 
interested  in  a  careful  examination  of  them.  There 
ought  undoubtedly  to  be  some  mode  of  ascertain- 
ing whether  a  vessel  may  be  safely  approached  by 
people  in  business,  or  whether  she  may  be  likely 
to  diffuse  pestilential  vapours  among  all  who  come 
within  their  reach.  Quarantine  is  also  one  of  the 
most  humane  regulations  in  favour  of  seamen, 
who  are  confessedly  a  very  useful  and  necessary 
class  of  the  community.  It  interposes  between 
them  and  the  carelessness  or  cruelty  of  their  com- 


Report  on  Yellow  Fever.  125 

mander,  and  makes  it  his  interest  to  preserve  their 
lives  and  health.  And  while  it  might  be  organized 
so  as  to  answer  all  these  purposes  efficaciously, 
it  might  also  be  properly  stripped  of  some  of  its 
useless  and  burthensome  appendages. 

If  the  facts  and  reasonings,  which  I  have  ad- 
duced to  prove  the  non-contagiousness  and  non- 
importation of  yellow  fever,  be  well  founded,  it 
results  that  our  epidemics  are  local,  domestic,  and 
as  incapable  of  exportation  to  foreign  nations,  as 
the  bilious  fever  of  the  country.  It  is  to  be  la- 
mented that  the  reverse  of  this  opinion  has  made 
so  deep  an  impression  in  Europe  ;  and  that  the 
governments  of  that  quarter  of  the  world  have 
suffered  themselves  so  lightly  and  hastily  to  em- 
brace doctrines  and  legislate  on  principles  contra- 
dicted by  all  former  experience.  It  is  now  more 
than  300  years  since  they  became  acquainted  with 
America.  And  although  the  first  discoverers  of 
the  new  world,  as  well  as  most  succeeding  adven- 
turers, have  largely  shared  the  effects  of  the  bane- 
ful climate  of  the  West- Indies,  it  is  only  of  late 
that  apprehensions  have  been  entertained  of  im- 
porting into  Europe  the  malignant  fevers  of  those 
islands.  The  shattered  remains  of  fleets  and  ar- 
mies had  often  returned  home  to  Great-Britain 
and  France,  in  the  most  sickly  state,  after  encouiir 
tering  all  the  horrors  of  yellow  fever,  without 
once   communicating  that   disease.      But   what 


126  Report  on  Yellow  Fever. 

transmutation  can  yellow  fever  undergo  in  the 
United  States,  which  renders  it  exportable  to 
Europe  from  us,  but  not  directly  from  the  West- 
Indies  ? 

It  affords  some  apology  indeed  for  Europe,  that 
the  information  concerning  this  subject,  upon 
which  they  have  acted,  was  derived  from  our  own 
country.  The  acts  of  our  State  Legislatures,  the 
proceedings  of  our  Municipal  Bodies  and  Boards 
of  Health,  the  proclamations  of  our  Magistrates, 
and  a  variety  of  other  public  documents,  have  all 
a  tendency  to  impress  the  same  opinion.  We 
have  held  up  to  foreign  nations,  an  indigenous 
and  local  disease,  growing  up  from  the  infelicities 
of  particular  situations,  or  from  neglects  of  police, 
and  entirely  incommunicable  from  one  person  to 
another,  as  highly  contagious,  capable  of  expor- 
tation to  distant  countries,  and  consequently  alarm- 
ing to  the  safety  of  the  whole  commercial  and  ci- 
vilized world.  We  cannot  transplant  the  disease 
from  this  city  to  the  neighbouring  villages  of 
Greenwich,  Brooklyn,  or  Newark  ;  and  yet  it  is 
believed  Ave  can  convey  it  3000  miles  across  the 
pure  air  of  the  Atlantic.  Whole  hospitals  of  pa- 
tients, labouring  under  the  most  malignant  forms  of 
the  disease,  with  all  the  foul  apparel,  bedding,  &c. 
polluted  with  the  excrementitious  discharges  and 
other  filth  of  the  sick,  the  dying  and  the  dead,  can- 
not emit  an  atom  of  contagion ;  and  yet  we  pretend 


Report  on  Yellow  Fever.  127 

to  dread  the  infectiousness  of  a  sailor's  jacket  or 
handkerchief,  or  even  of  the  cordage  and  timbers 
of  a  vessel.  Under  the  influence  of  this  phantom 
of  contagion,  we  have  instructed  the  Europeans  to 
enact  laws  and  regulations,  sanctioned  by  the 
highest  penalties,  which  retard  and  oppress  our 
commerce,  and  subject  our  shipping  in  their  ports 
to  the  most  grievous  detention.  To  crown  the 
whole  of  this  injury  and  humiliation,  we  have  in- 
stigated them  to  place  the  people  of  the  United 
States,  by  late  extensions  of  quarantine,  on  the  same 
footing  with  the  degraded  and  detestable  inhabi- 
tants of  Barbary,  Egypt,  Syria,  the  Archipelago, 
Constantinople  and  other  parts  of  the  Turkish  do- 
minions. And  all  this  has  been  done,  in  defiance 
of  clear  and  luminous  facts,  and  in  the  face  of  long, 
reiterated  and  ample  experience. 

By  discarding  the  bugbear  of  contagion,  the 
origin  and  nature  of  Yellow  Fever  will  be  more 
truly  ascertained ;  the  means  of  personal  safety 
more  generally  understood  ;  and  the  measures  ne- 
cessary to  improve  the  salubrity  of  the  city  more 
vigorously  pursued.  The  public  will  no  longer 
witness  that  desertion  and  misery  of  the  sick, 
which  have  too  often  disgraced  society,  in  every 
epidemic.  The  bosom  of  humanity  will  no  longer 
be  wrung  with  the  sufferings  of  our  fellow-crea- 
tures, driven,  while  under  the  pressure  of  this 
calamity,  from  every  place  of  shelter,  deprived  of 


128  Report  on  Yellow  Fever, 

comfort,  and  abandoned  to  their  fate,  from  the 
false  impression  of  danger  in  affording  them  as- 
sistance. By  telling  the  community  the  truth, 
we  shall  lessen  apprehension  and  distress,  we  shall 
disarm  the  evil  of  half  its  power,  and  restore  the 
ties  of  kindred  and  of  nature.* 


*  The  learned  Dr.  Hunter,  one  of  the  members  of  the 
National  Board  of  Health  of  Great  Britain,  offers  the  fol- 
lowing argument  in  support  of  his  opinion  of  the  non-con- 
tagiousness of  Yellow  Fever.  "  The  strongest  proofs  of 
this,  in  my  opinion,  were  to  be  met  with  in  private  families, 
where  the  son,  the  brother,  or  the  husband,  labouring  under 
the  worst  fevers,  were  nursed  with  unremitting  assiduity  by 
the  mother,  the  sister,  or  the  wife,  who  never  left  the  sick 
either  by  day  or  by  night,  yet  without  being  infected.  That 
such  near  relations  should  take  upon  them  the  office  of  a 
nurse,  is  matter  of  the  highest  commendation  in  a  country, 
the  diseases  of  which  require  to  be  watched  with  greater  care 
and  attention  than  can  be  expected  from  a  servant.  They 
are  under  no  fears  of  the  fever  being  infectious,  and  I  never 
saw  any  reason  to  believe  it  to  be  so,  either  in  private  families, 
or  in  the  military  hospitals."  That  Dr.  Hunter  came  to  this 
decision,  after  a  full  and  mature  consideration  of  the  impor- 
tance of  the  subject,  will  appear  from  the  following  remarks : 
"  There  is  hardly  any  part  of  the  history  of  a  disease,  which 
it  is  of  more  consequence  to  ascertain  with  accuracy,  than 
its  being  of  an  infectious  nature,  or  not.  Upon  this  depends 
the  propriety  of  the  steps  that  should  be  taken,  either  to  pre- 
vent it,  or  to  root  it  out.  It  is  productive  of  great  mischief 
to  consider  a  disease  as  infectious,  that  really  is  not  so  ;  it 
exposes  such  as  labour  under  it  to  evils  and  inconveniencies, 
which  greatly  aggravate  their  sufferings,  and  often  deprive 
them  of  the  necessary  assistance.    They  are  neglected,  if 


Report  on  Yellow  Fever,  129 

it  is  surely  time  to  investigate  this  subject  with 
the  deepest  attention,  and  to  adopt  some  adequate 
system  of  relief.  The  warning  voice  of  history 
and  experience  loudly  calls  us  to  make  every  ex- 
ertion to  deliver  our  city  from  nuisances,  which 
threaten  to  entail  the  miseries  of  an  annual  succes- 
sion of  malignant  epidemics.     We  live  in  the 

LATITUDE  OE  PESTILENCE,  AND  OUR  CLI- 
MATE NOW  PERHAPS  IS  ONLY  BEGINNING 
TO      DISPLAY      ITS      TENDENCY      TO      PRODUCE 

this  terrible  scourge. f  The  impurities, 
which  time  and  a  police,  rather  moulded  in  con- 
formity to  the  usages  of  more  northern  countries 
than  to  the  exigencies  of  our  own,  have  been  long 
accumulating,  are  now  annually  exposed  to  the- 
heats  of  a  burning  summer,  and  send  forth  exha- 
lations of  the  highest  virulence.  The  examples 
of  similar  calamities  in  many  parts  of  the  old  con- 
tinent, ought  long  since  to  have  taught  us  lessons 

not  shunned  ;  and  at  the  time  they  require  the  greatest  care 
and  attention,  they  have  the  least." 

Observ.  on  the  Diseases  of  the  Army  in  Jamaica,  page  177 
k  178. 

f  To  convince  the  reader  of  this,  it  is  only  necessary  to 
remind  him  how  near  the  cities  of  Philadelphia  and  New* 
York  lie  to  the  parallels  on  which  Rome  and  Constantinople 
are  situated.  It  is  scarcely  requisite  to  observe,  that  the 
ravages  of  pestilence  in  these  ancient  cities  have  far  exceed- 
ed any  thing  which  has  occurred  elsewhere,  unless  those  of 
Grand  Cairo  should  be  supposed  to  equal  them. 

R 


130  Report  on  Yellow  Fever. 

of  wisdom.  In  the  city  of  Rome,  time  and  fatal 
experience  pointed  out  the  necessity  of  erecting 
extensive  and  costly  public  works,  in  order  to  de- 
liver the  inhabitants  from  the  horrors  of  pesti- 
lence ;  and  the  air  of  that  city  was,  at  several  pe- 
riods of  its  history  in  alternate  succession,  observed 
to  become  pestilential  or  salubrious,  as  these  pub- 
lic works  were  suffered  to  fall  into  decay,  or  were 
repaired  and  renewed. 

The  different  opinions  of  the  origin  of  Yellow 
Fever,  offer  us  only  the  alternative  of  a  more  rigid 
quarantine,  or  of  more  vigorous  internal  measures. 
Every  step  of  increasing  restriction  in  our  system 
of  quarantine,  has  only  served  to  shew  more  clear- 
ly the  domestic  origin  of  the  disease.  If  an  entire 
prohibition  of  the  West- India  trade,  or  a  prohibi- 
tion during  the  summer  and  autumn,  were  impo- 
sed by  law,  the  effect  would  soon  be  sufficient 
to  banish  every  doubt  from  the  mind  of  the  pub- 
lic. How  far  the  advantage  of  unanimous  convic- 
tion might  be  supposed  to  countervail  the  burthen 
of  such  restrictions  for  a  short  period  of  years,  I 
shall  not  undertake  to  decide. 

But  whatever  opinion  may  be  embraced,  the 
present  moment  is  certainly  not  the  time  for  the 
indulgence  of  apathy  or  inactivity.  If  the  Legis- 
lature, in  their  wisdom,  should  still  think  that 
this  disease  is  introduced  from  abroad,  they  are 


Report  on  Yellow  Fever.  131 

bound  by  the  strongest  obligations  to  extend  the 
powers  of  quarantine,  by  additional  restrictions. 
The  conveniencies  of  trade  are  not  to  be  put  in 
competition  with  the  ravages  of  yellow  fever.  If  it 
be  necessary  to  resign  the  freedom  of  commerce, 
or  to  incur  the  miseries  of  pestilence,  let  the  for- 
mer be  freely  abandoned. 

It  is  likewise  my  duty,  before  I  conclude,  to 
suggest  whatever  it  may  be  deemed  advisable 
to  do  towards  the  removal  of  existing  nuisances, 
and  the  improvement  of  the  salubrity  of  the  city. 
This  task  has  been,  in  some  degree,  anticipated 
in  my  letter  to  Governor  Clinton,  after  the  epi- 
demic in  1803.  Unfortunately,  some  of  the  re- 
quisite measures  will  demand  great  expense,  and 
must  bring  to  a  test  the  liberality,  enterprise  and 
public  spirit  of  the  City  and  State.  Among  the 
improvements  of  the  most  urgent  and  immediate 
necessity,  I  consider  the  following,  to  wit ;  Wa- 
ter',  obtained  from  a  distant  source,  of  pure  qual- 
ity, and  in  quantity  sufficient  to  allow  a  constant, 
plentiful,  and  increasing  expenditure  ;  Sewers,  of 
such  number,  capacity  and  construction,  as  com- 
pletely to  drain  all  the  low  and  marshy  districts,  to 
carry  away  all  filth,  and  to  be  constantly  washed 
by  a  brisk  current  of  water  ;  a  new  arrangement 
and  construction  of  wharves,  docks,'  &c.  so  as  to 
face  the  margin  of  the  two  rivers  with  a  stone  quay, 
impervious  to  water  ;  a  prohibition  to  make  a  sin* 


132  Report  en  Yellow  Fever. 

gle  additional  foot  of  artificial  ground  on  either  of 
the  rivers  ;  a  different  modification  of  privies, 
which  are  every  day  becoming  more  and  more  an 
alarming  nuisance,  and  will  soon  underlay  with 
filth  a  large  portion  of  the  city  ;  a  better  plan  of 
paving,  more  particularly  as  respects  the  construc- 
tion of  gutters,  &c. ;  the  draining  of  all  stagnant 
waters  in  the  town  and  neighbourhood ;  the  filling 
up,  levelling  and  paving  all  low  and  depressed  lots 
and  places  of  whatever  description  ;  and  a  pro- 
hibition hereafter  to  inter  dead  bodies  in  any  part 
of  the  city.  Many  other  objects,  which  would  re- 
quire much  minuteness  of  detail,  likewise  demand 
attention  ;  and  will  acquire  great  additional  im- 
portance from  the  rapid  progress  of  building  and 
population. 

I  have  the  honour  to  be, 
With  great  respect, 

Your  Excellency's  most  obedient 
And  humble  servant, 

EDWARD  MILLER, 
Resident  Physician* 


APPENDIX. 


UNDER  this  title,  it  is  intended  to  lay  before 
the  reader  some  proofs  and  illustrations  of  the 
principles  delivered  in  the  foregoing  Report, 
which  could  not  properly  be  admitted  into  the  let- 
ter itself,  and  which  are  too  long  to  have  been 
conveniently  subjoined  in  the  form  of  notes. 


On  the  analogy ',  as  to  localities  and  diseases,  be- 
tween the  cities  of  Rome  and  New-York. 

It  is  from  the  south  of  Europe,  and  chiefly 
from  Spain  and  Italy,  that  inquirers  into  the  en' 
demic  diseases  of  the  United  States  may  expect  to 
derive  the  most  valuable  lessons  of  time  and  ex- 
perience. The  writings  of  the  Italian  physicians 
in  particular,  are  full  of  instruction  on  this  subject ; 
and  it  is  to  be  lamented,  that  this  instruction  has 
not  been  more  eagerly  sought  for,  and  more  gen. 
erally  obtained  by  their  American  brethren. 


134  Report  on  Yellow  Fever. 

By  considering  the  following  account  of  the  lo- 
calities and  diseases  of  Home,  given  by  Baglivi, 
and  comparing  them  with  those  of  Arew-  York,  we 
perceive  how  exactly  like  causes  will  produce 
like  effects,  in  the  old  and  in  the  new  continent. 

"  Ut  res  exemplo  fiat  clarior,  exponemus  bre- 
"  viter,  qua?  nos  Roma?  circa  aeris  temperiem,  et 
"  medendi  methodum  quotidiano  usu  experimur. 
"  Aer  Romanus  septem  collibus,  Orbis  dominis, 
"  hodie  interclusus,  natura  humidus  est  et  gravis  ; 
"  experimento  namque  constat,  quod  si  quis  paulo 
"  longius  a  frequentia  tectorum  processerit,  quan- 
'*  tarn  coeli  gravitatem  atque  intemperiem  mani- 
"  festo  concipiet.  Insaluberrimis  Austri,  Africi 
■'  atque  Euronoti  flatibus  obnoxius  :  ab  a?stivis 
"  caloribus  interdum  tantopere  exardescit,  ut  mi- 
f*  rum  non  videatur,  si  Consulibus  L.  Valerio  Po- 
"  tito,  et  M.  Manlio,  Pestilentia  orta  sit  in  agro 
>'  Romano,  ob  siccitates  et  nimios  solis  calores,  teste 
*'  Livio,  lib.  V.  His  aliisque  de  causis  infra  di- 
"  cendis,  Incolce  urbis  temperamento  praediti  sunt 
u  melancholico,  subfusco,  et  nonnulli  subpallido 
*'  cutis  colore,  habitu  corporis  macilento  potius 
"  quam  pingui  ;  levi  de  causa  capite  afficiuntur, 
"  et  iis  morbis  potissimum  subjacent,  quos  aeris 
"  gravitas  solet  producere,  sicuti  sunt  pulmonis 
"  vitia,  febres  maligna?,  cachexia?,  pallores  vultus, 
"  incubus,  tabes  et  consimiles.  Porro  aer  Roma- 
u  nus  squalidus  quoque  est  et  insalubris,  non  qui- 


Report  on  Yellow  Fever.  135 

"  dem  omnibus  in  locis,  sed  iis  potissimum,  quae 
"  deficientibus  aedificiis,  pigro  atque  immoto  aere 
"  sordescunt  ;  multo  magis  si  Tiberi  adhaerent, 
f*  vel  convallium  instar,  montibus  obsepiuntur,  aut 
"  exhalationibus  subjacent  quas  veteres  parietinae, 
'•'  cryptae,  et  antiquorum  aedificiorum  rudera 
"  emittunt.  Ex  quo  patet  Regionem  Circi  Max- 
"  imi,  inter  Palatinum  atque  Aventinum  sitam, 
"  omnemque  ilium  campum  qui  inter  Aventinum, 
"  ac  Tiberim,  portamque  Ostiensem,  jacet,  plane 
"  noxium  esse  et  damnabilem.  Sed  ut  rem  uni- 
"  versam  definiam.  Quaecunque  loca  crebis  aedi- 
"  ficiis  ambiuntur,  atque  editiora  sunt,  in  septen- 
,;  trionem  atque  orientem  spectant,  et  multum  a 
i:  Tiberi  distant,  salubriora  :  Contra,  quae  se- 
"  juncta  sunt,  et  remota  a  frequentibus  tectis,  situ- 
"  que  sunt  humili,  ac  maxime  in  convallibus,  turn 
"  propiora  Tiberi,  in  meridiem  atque  occasum 
"  spectantia,  minus  salubriora  judicantur  :  Qui- 
M  bus  etiam  in  locis  (quod  sane  mirum)  brevis- 
*'  simi  inter valli  discrimine,  hie  aliquantum  salu- 
"  bris  existimatur  aer  ;  illic  contra  noxius  et  dam- 
"  nabilis. 

**  Insalubritatem  hanc  urbani  aeris,  fovet  magna 
"  ex  parte  adjacens  Latium  ;  quod  undequaque 
"  corona  montium  circumcingitur,  excepto  tractu 
"  illo,  qua  mediterraneum  vergit,  ubi  in  planitiem 
'.*  desinit.  Vetus  enim  Latium  desertum  fere 
"  hodie  est  et  squalidum ;  Austri  flatibus  imme- 


136  Report  on  Yellow  Fever. 

"  diate  objicitur  ;  et  variis  ejusdem  in  locis,  in- 
"  saluberrimus  aer  observatur,  utpote  circa  Os- 
"  tiam  et  Portum,  aestivo  praesertim  tempore ; 
"  quo  quidem  si  aliquis  in  praefatis  aliisque  Latii 
"  locis  pernoctaverit,  et  exinde  urbem  revertatur, 
"  corripitur  statim  maligna  febri,  quam  vulgo,  ex 
"  mutatione  aeris  dicunt ;  estque  febris  haec  sui 
"  generis,  ab  aliis  febribus,  alias  agnoscentibus 
"  causas  summopere  differens,  turn  in  methodo 
"  curativa,  turn  in  symptomatis  eandem  concom- 
"  itantibus." 

Georg.  Baglivi  Oper.  Omn.  pag.  157,  158. 

Lancisi,  in  his  valuable  work  De  Noxiis 
Paludum  Effluviis,  confirms  the  facts  stated  by 
Baglivi,  and  adds  many  others  which  are  ex- 
tremely important.  In  his  account  of  a  malignant 
epidemic,  in  the  summer  and  autumn  of  1695, 
which  ravaged  a  particular  district  of  the  city  of 
Rome  to  such  a  degree  as  nearly  to  depopulate  it, 
he  traces  the  disease  to  its  cause  in  the  following- 
words  : 

"  Nemo  sane  luctuosa  funera  per  id  temporis 
t{  Romae  conspiciens,  fcetoremque  in  vicis  illis 
"  persentiens,  dubius  haesit,  quin  causa  maligna- 
"  rum,  perniciosarumque  febrium,  quae  publice 
"  vagabantur,  fuerit  multitudo  stagnantium  et 
"  corruptarum  aquarum,  turn  in  scrobibus  prato- 
li  rum,  turn  in  magna  cloaca,  atque  in  fossa  po- 


Report  on  Yellow  Fever.  137 

tissimum  Hadrianae  arcis.  Tellusjam  erat  hu- 
mida,  cum  Tiberis  propter  magnam  vim  aquae 
bis  auctus  est;  atque  idcirco  non  solum  scrobes, 
ac  fossae  pratorum  et  Arcis  exhauriri  non  potu- 
erunt ;  verum  quod  maxime  aeris  insalubrita- 
tem  inducit,  sordes,  quae  pluviis  prolutae  ever- 
runtur,  ac  dilabuntur,  iis  in  canalibus  atque  in 
eloacis  subsistere  coactae  sunt.  Simul  etiam 
per  humiliora  Leoninae  civitatis  loca  exundavit, 
subterraneasque  cellas,  multosque  pauperum 
puteos  hie  illic  contemeravit.  Posthaec,  negli- 
gentia  eorum,  qui  rebus  publicis,  atque  eidem 
praesertim  Arci  praeerant,  nullum  studium  pur- 
gandis  hisce  regionibus  adhibitum  fuit.  Hinc 
mira  haec  proluvies  in  limosam  paludem  sensim 
intra  fossas  scrobesque  conversa,  virescere,  jam 
urgente  aestu,  fermentari,  computrescere,  varia- 
que  insecta  admittere  coepit.  His  vero  malis 
accessit  etiam  frequens  afflatus  Vulturni,  austri- 
norumque  ventorum,  qui  a  medio  Maio  usque 
ad  Septembrem  identidem  recurrentes,  non  tan- 
tum  deteriori  putredini  immotarum  aquarum, 
verum  faciliori  quoque  sublimationi  ac  dela- 
tioni  malignorum  effluviorum  non  in  vicinas 
duntaxat  aedes,  sed  etiam  usque  ad  finitimas 
adversasque  regiones,  ansam  praebutrunt." 

Lands.  Oper.  Far.  Tom.  I.  p.  189. 


138  Report  on  Yellow  Fever. 

On  the  antiquity  of  the  Yellow  Fever. 

It  has  been  contended  by  some,  that  the  yellow- 
fever  is  a  modern  disease,  and  utterly  unknown  to 
Europe,  except  when  imported  there  from  Ame- 
rica. A  slight  inspection  of  the  writings  of  Hip- 
pocrates, who  flourished  upwards  of  four  hun- 
dred years  before  the  Christian  aera,  will  be  suffi- 
cient to  prove  that  he  was  familiarly  acquainted 
with  it,  and  had  observed  it  under  its  most  malig- 
nant and  fatal  forms. 

The  two  symptoms  which  are  considered  as 
most  characteristic  of  this  fever,  are  yellowness  of 
skin,   and  black  vomiting.     A  great  number  of 
passages  might  be  adduced  to  shew  that  Hippo- 
crates frequently  met  writh  these  symptoms  in  the 
malignant  fevers  which  fell  under  his  care.     I 
shall  mention  only  such  as  are  clear,  pointed,  and 
incapable   of  being  mistaken.     In  the  ninth  sec- 
tion of  his  book  of  Crises,  he  lays  it  down  as  a 
maxim,  that  "  in  burning  fevers,  a  yellowness  of 
skin  appearing  on  the  fifth  day,  and  accompanied 
by  hiccough,  is  a  fatal  symptom."*     This  is  a 

*  For  the  sake  of  removing  all  doubt  on  this  subject,  it 
is  proper  to  submit  the  original  to  the  reader's  considera- 
tion : — 

Ev  roicri  kccvg-oig-iv  exv  rsTtytvyTxi  tKJipoi  xxi  hvtyi  ire/vrlccia)  torn, 


Report  on  Yellow  Fever.  133 

very  brief,  exact,  and  appropriate  description  of 
the  disease.  A  greater  number  are  said  to  die  of 
yellow  fever  on  the  sixth  than  any  other  day  of  the 
disease  ;  and  it  very  frequently  happens  that  ap- 
pearances of  yellowness  are  discovered  on  the  fifth, 
which,  at  that  period,  and  accompanied  by  hic- 
cough, constitute  a  fatal  symptom.  When  the 
description  which  Hippocrates  gives  of  Causus,  or 
Burning  Fever,  is  duly  recollected,  and  there  is 
connected  with  this  fever  the  occurrence  of  yel- 
low skin,  accompanied  with  hiccough,  on  the  fifth 
day,  a  character  results,  which  can  apply  to  no 
other  disease  in  the  world  but  yellow  fever.  And 
it  would  be  exceedingly  difficult,  in  so  few  words, 
to  present  a  more  expressive  delineation  of  that 
distemper. 

The  terrible  symptom  of  black  vomiting  is  also 
frequently  mentioned  by  Hippocrates,  and  repre- 
sented as  being  of  fatal  import.  He  uses  the 
phrases  (*.(>miw  %<>>w  black  bile,  ^^xm  e^slov  black  vo- 
mit, and  petotvm  tpelov  the  vomiting  of  black  matter. 
In  the  twelfth  section  of  his  Prognostics,  lie  as- 
serts, that  if  the  matter  vomited  be  of  a  livid  or 
black  colour,  it  betokens  ill.  In  the  first  sectiojj 
of  the  first  book  of  his  Coon  Prognostics*  he  enu- 
merates black  vomiting  in  a  catalogue  of  the  most 
fatal  symptoms.  And  also  in  the  fourth  section 
of  the  same  book,  he  considers  porraceous,  livid 


140  Report  on  Yellow  Fever. 

or  black  vomiting  as  indications  of  great  malig- 
nancy.* 

The  importance  of  this  conclusion  is  further 
illustrated  and  confirmed  by  adverting  to  the  well- 
known  fact,  that  Hippocrates  practised  physic  for 
a  considerable  portion  of  his  life,  in  parts  of  Greece 
situated  nearly  in  the  same  parallel  of  latitude  with 
those  in  the  United  States,  where  the  yellow  fe- 
ver has  produced  its  greatest  ravages. 

See  Medical  Repository,  Hex.  11.  Vol.  3,  page  107. 

On  another  account,  the  writings  of  Hippocra- 
tes offer  important  instruction  concerning  malig- 
nant fevers.  Not  the  least  reference  to  contagion 
is  to  be  found  in  any  part  of  them.  If  personal 
intercourse  between  the  sick  and  the  well  had  been 
the  means  of  spreading  these  fevers  from  one  in- 
dividual, or  from  one  family  to  another,  it  is  in- 
credible that  so  prominent  and  glaring  a  fact 
should  have  escaped  the  notice  of  a  person  en- 
dowed with  such  talents  for  extensive,  accurate 
and  discriminating  observation. 


Yellow  Fever  indigenous  in  the  Island  of  Minorca. 
By  the  following  quotation  from  Cleghorn^s  Ob- 

*  Ej  £t  £ty  to  ip,£vft.iv6v  irpxrotiSis,  y  7re\tov,   y  /i«A<*v,  cti  «»'sj 


Report  on  Yellow  Fever.  141 

servations  on  the  Epidemical  Diseases  of  Minorca, 
from  the  year  1744  to  1749,  page  175  &  176,  it 
appears  that  yellow  fever  often  prevailed  in  that 
island  more  than  sixty  years  ago,  and  that  it  was 
by  no  means  considered  as  a  new  or  extraordinary 
disease.  It  also  appears,  that  the  characteristic 
symptoms  of  yeilow  fever  are  often  superinduced 
on  the  intermittent  fevers  of  that  place,  and  that 
their  common  tertian  fevers  are  only  a  lower  grade 
of  yellow  fever.  The  island  of  Minorca  is  situa- 
ted nearly  in  our  latitude. 

"  But  the  utmost  danger  is  to  be  apprehended, 
"  if  a  few  drops  of  blood  fall  from  the  nose :  if 
"  black  matter  like  the  grounds  of  coffee;  is  dis- 
"  charged  upwards  or  downwards  :  if  the  urine 
"  is  of  a  dark  hue  and  a  strong  offensive  smell : 
"  if  the  whole  skin  is  tinged  with  a  deep  yellow, 
"  or  any  where  discoloured  with  livid  spots  or 
"  suffusions  :  if  a  cadaverous  smell  is  perceptible 
"  about  the  patient's  bed  :  if  in  the  time  of  the 
"  fit  he  continues  cold  and  chilly,  without  being 
"  able  to  recover  heat ;  or  if  he  becomes  extreme- 
"  ly  hot,  speechless  and  stupid  ;  has  frequent 
"  sighs,  groans,  or  hiccoughs  ;  and  lies  constantly 
"  on  his  back,  with  a  ghastly  countenance,  his 
"  eyes  half  shut,  his  mouth  open,  his  belly  swelled 
"  to  an  enormous  size,  with  an  obstinate  costive- 
"  ness,  or  an  involuntary  discharge  of  the  excre- 
"  ments :  which  formidable  symptoms,  as  they 


142  Report  on  Yelloxv  Fever. 

"  seldom  appear  before  the  third  revolution  of  the 
"  disease,  so  they  frequently  come  on,  both  in 
u  double  and  simple  intermittents,  during  the 
"  fourth,  fifth,  or  sixth  period,  even  where  the 
"  smallest  danger  was  not  foreseen."  The  au- 
thor likewise  adds,  in  a  note,  that  "  The  English 
"  in  Minorca  are  more  liable  than  the  natives  to 
*  become  yellow  in  these  fevers." 


On  Yellow  Fever  in  the  interior  of  the  Country. 

Sporadic  cases  of  this  disease  are  occasion- 
ally observed  in  all  parts  of  the  country.  They 
are  found  more  frequently  and  in  greater  number 
in  low  and  marshy  districts,  near  lakes,  mill-ponds, 
swamps,  &c.  The  most  respectable  physicians 
in  the  country  so  universally  concur  in  this  obser- 
vation, that  it  would  be  unreasonable  to  contest 
the  fact. 

In  some  of  the  more  exposed  situations,  and 
after  very  hot  and  damp  summers,  the  yellow  fe- 
ver often  assumes  an  epidemic  appearance  in  the 
country.  The  malignant  disease  at  Catskill  in 
this  State,  in  the  year  1803,  (see  Medical  Reposi- 
tory) vol.  8,  page  105)  affords  an  instance  of  this 
kind.     In  the  year  1793,  it  prevailed  in  many 


Report  on  Yellow  Fever.  143 

parts  of  the  country  in  the  eastern,  middle  and 
southern  States,  where  no  suspicion  of  contagion 
could  exist. 

The  venerable  Dr.  Anthon,  of  this  city, 
whose  accurate  acquaintance  with  the  pestilential 
epidemics  of  New- York  enables  him  to  decide  in 
the  most  satisfactory  manner,  assures  me  he  has 
often  seen  the  same  disease  in  the  interior  coun- 
try, and  particularly  in  the  low  situations  near  the 
river  Illinois,  after  an  extensive  inundation  of  that 
river,  succeeded  by  hot  weather. 

Mr.  Volney  found  yellow  fever  in  several 
parts  of  the  interior  western  country,  during  his 
travels  in  America,  and  describes  the  disease  with 
so  much  accuracy  and  force,  that  no  doubt  of  his 
testimony  can  be  entertained. 

See  his  View  of  the  Climate  and  Soil  of  the  United  States. 

Out  of  a  great  mass  of  particular  instances  of 
the  appearances  of  yellow  fever  in  situations  in- 
accessible to  foreign  contagion,  I  shall  only  now 
select  the  following : 

Extract  from  Mr.  Andrew  Ellicotfs  Voyage 
down  the  River  Ohio,  in  the  month  of  Novem- 
ber, 1796. 

"  November  15th. 
"  Arrived  at  Galliopolis  about  11  o'clock  in  the 


144  Report  on  Yellow  Fever, 

morning. — This  village  is  a  few  miles  below  the 
mouth  of  the  Great  Kanhaway,  on  the  west  side 
of  the  Ohio  river,  and  situated  on  a  high  bank  ;  it 
is  inhabited  by  a  number  of  miserable  French  fa- 
milies. Many  of  the  inhabitants,  this  season,  fell 
victims  to  the  yellow  fever.  The  mortal  cases 
were  generally  attended  with  the  black  vomiting. 
This  disorder  certainly  originated  in  the  town, 
and,  in  ail  probability,  from  the  filthiness  of  the  in- 
habitants, added  to  an  unusual  quantity  of  animal 
and  vegetable  putrefaction  in  a  number  of  small 
ponds  and  marshes  within  the  village. 

"  The  fever  could  not  have  been  taken  there 
from  the  Atlantic  States,  as  my  boat  was  the  first 
that  descended  the  river  after  the  fall  of  the  waters 
in  the  spring  :  neither  could  it  have  been  taken 
from  New- Orleans,  as  there  is  no  communication, 
at  that  season  of  the  year,  up  the  river,  from  the 
latter  to  the  former  of  those  places  :  moreover,  the 
distance  is  so  great,  that  a  boat  would  not  have 
time  to  ascend  the  river,  after  the  disorder  appear- 
ed that  year  in  New-Orleans,  before  the  winter 

would  set  in." 

See  EllicoWs  Journal. 

The  following  fact  is  communicated  by  Dr.    IVaU 
kins,  from  his  personal  knowledge. 

There  is  a  village  called  New- Design,  about 
fifteen  miles  from  the  Mississippi,   and  twenty 


Report  on  Yellow  Fever,  145 

miles  from  St.  Louis,  containing  about  forty 
houses  and  two  hundred  souls.  It  is  on  high 
ground,  but  surrounded  by  ponds.  In  1797.,  the 
yellow  fever  carried  off  fifty-seven  of  the  inhabi- 
tants, or  more  than  a  fourth.  No  person  had  ar- 
rived at  that  village  from  any  part  of  the  country 
where  this  fever  had  prevailed,  for  more  than 
twelve  months  preceding.  Our  informant  resided 
in  the  village  at  the  time  ;  and,  having  seen  the 
disease  in  Philadelphia,  he  declares  it  to  be  the 
same  that  prevailed  at  New-Design.  He  also 
mentions  an  Indian  village  depopulated  by  the 
same  disease  two  or  three  years  before. 

See  Medical  Repository,  vol.  4,  page  74. 

Fever,  with  black  vomiting,  in  the  middle  part  of 
Pennsylvania,  west  of  the  Susquehannah. 

"  The  fever  which  prevailed,  in  the  autumn 
and  winter  of  1799,  in  Nittany  and  Bald- Eagle 
Valley,  in  Mifflin  county,  Pennsylvania,  proved, 
in  a  number  of  cases,  mortal.  Bald- Eagle  Valley, 
situated  about  200  miles  N.  N.  W.  of  Philadel- 
phia, is  low,  abounding  with  much  stagnated 
water  in  ponds,  which,  from  the  dryness  of  the 
season,  became  very  putrid  and  offensive  to  the 
smell.  Near  to  these  waters  the  fever  prevailed 
with  great  malignity.  It  was  ushered  in  by  chills, 
with  pains  in  the  back,  limbs  and  head,  which,  in 
48  or  60  hours  carried  off  the  patients. — They 


146  Report  on  Yellow  Fever. 

discharged  vast  quantities  of  filth  from  the  sto- 
mach, of  the  consistence  and  appearance  of  coffee- 
grounds,  so  offensive  in  smell  as  to  produce  nau- 
sea, and  even  vomiting,  in  the  attendants.  The 
feces  also  had  the  same  appearance.  In  many  the 
disease  terminated  by  profuse  discharges  of  blood 
from  the  anus  and  vagina. 

Ibid,  page  75. 


On  Dr.  Chisholm's  singular  opinions  concerning 
Yellow  Fever. 

It  is  well  known  that  this  gentleman  contends 
for  the  production  of  a  new  and  peculiar  pestilen- 
tial disease,  which  he  supposes  to  have  been  im- 
ported by  the  ship  Hankey,  in  the  year  1793,  from 
Boullam,  on  the  coast  of  Africa.*  He  believes 
this  new  distemper  to  have  been  spread  through 
the  West- India  islands  and  transmitted  to  this 
country.  He  admits  that  the  yellow  fever  of  the 
West- Indies  is  not  a  contagious  disease.  The 
importers  and  contagionists  in  the  United  States, 
assuming  his  opinion,  and  fortifying  themselves 
by  his  authority,  assert  that  our  epidemics  are  not 
the  yellow  fever  of  the  West- Indies,  but  a  con- 
tinuation of  the  new  and  peculiar  Boullam  fever. 

*  An  Essay  on  (he  Malignant  Pestilential  Fever,  &.c.  2d 
Edit,  in  2  vols. 


Report  on  Yellow  Fever.  147 

But  the  slightest  examination  of  the  subject  is 
sufficient  to  satisfy  an  impartial  inquirer,  that  the 
Boullam  fever  of  Dr.  Chisholm  and  the  yellow  fe- 
ver of  the  West- Indies,  are  precisely  the  same 
disease  ;  and  that  only  such  occasional  variations 
of  grade  have  been  observed  in  it,  as  are  found  in 
the  different  epidemic  seasons  of  all  pestilential 
distempers.  The  ravages  of  pestilence  in  the 
West- Indies,  since  the  pretended  introduction  of 
the  Boullam  disease,  among  a  given  number  of 
Europeans,  or  other  strangers  recently  arrived,  or 
among  the  natives  themselves,  are  not  greater  than 
they  were  fifty  years  ago,  or  during  the  war  of  the 
American  Revolution.  The  great  body  of  phy- 
sicians and  people  in  the  West- Indies,  do  not  find 
the  fever  now  prevailing  at  all  different  from  what 
it  was  many  years  before  the  arrival  of  the  ship 
Hankey  from  Boullam.  The  descriptions  of  the 
disease  by  physicians  who  wrote  forty,  fifty  and 
sixty  years  ago,  precisely  agree  with  what  is  now 
observed  in  those  islands  and  on  this  continent. 
And  in  this  city,  the  yellow  fever  prevailed  in  the 
autumn  of  1791,  two  years  before  the  supposed 
arrival  of  the  Boullam  disease  by  the  ship  Hankey. 

Without  recurring,  however,  to  facts  of  this 
kind,  Dr.  Chisholm's  doctrine,  considered  in  it- 
self, cannot  stand  the  test  of  examination.  All 
his  leading  assertions  concerning  the  pretended 
introduction  of  the  Boullam  fever  into  the  West 


148  Report  on  Yellow  Fever. 

Indies,  are  positively  denied  by  Mr.  Paiba,  a  gen- 
tleman of  intelligence  and  unblemished  character, 
who  was  on  board  of  the  ship  charged  with  the 
importation,  during  the  whole  of  the  voyage.  The 
narrative  itself  of  the  voyage,  and  of  the  disease 
supposed  to  have  been  imported,  betrays  inherent 
evidence  of  mistake.  And  even  if  Dr.  Chisholm's 
story  be  admitted,  it  is  only  an  instance  of  malig- 
nant disease  generated  in  a  vessel,  as  he  does  not 
pretend  to  derive  it  from  the  Africans. 

Dr.  Chisholm  makes  a  very  elaborate  attempt 
to  discriminate  the  features  of  the  Boullam  fever 
from  those  of  the  yellow  fever  of  the  West- Indies. 
It  is  apparent  that  there  is  no  foundation  for  the 
distinction  ;  and  that  he  only  describes  different 
grades  of  the  same  disease,  modified  and  rendered 
more  malignant  at  one  time  than  another,  by  pe- 
culiarities of  season.  This  happens  with  respect 
to  all  epidemic  diseases.  The  measles,  for  ex- 
ample, in  one  season,  are  mild  and  safe,  at  another, 
they  are  malignant  and  fatal;  in  one  epidemic  they 
are  highly  inflammatory,  in  another  they  may  be 
highly  putrid ;  yet  are  they  not  essentially  the 
same  disease  ?  But,  admitting,  for  argument's 
sake,  the  distinction  contended  for  by  Dr.  C.  it 
may  be  still  asserted  that,  in  his  description  of  the 
ordinary  yellow  fever  of  the  West- Indies,  and  not 
in  that  of  the  Boullam  fever,  he  gives  the  character 
of  the  disease  which  has  so  often  prevailed  in  this 
city. 


Report  on  Yellow  Fever.  149 

It  is  creditable  to  the  candour  of  Dr.  Chisholm 
that  he  seems  lately,  in  a  considerable  degree,  at 
least  in  effect,  to  have  given  up  his  favourite 
opinion.  He  now  admits  that  a  disease,  similar 
to  that  of  Boullam,  has  been  since  generated  on 
board  of  a  filthy  ship  from  England.  It  is  proper 
to  give  his  own  words,  as  expressed  in  an  extract 
of  a  letter  to  Dr.  Davidson,  dated  Demarara,  Au- 
gust 10,  1800,  a  period  of  seven  years  after  the 
formation  of  his  first  opinion. 

"  A  fever  of  a  most  alarming  nature  has  most 
fatally  prevailed  since  the  beginning  of  July.  I 
have  visited  a  few  of  the  sick  at  the  request  of 
Doctors  Dunkin  and  Lloyd  in  town,  and  of  Dr. 
Ord  on  this  coast ;  and  I  have  no  hesitation  in 
pronouncing  it  a  fever  of  infection.  Its  features 
are,  almost  without  exception,  precisely  those  of 
the  malignant  pestilential  fever  of  Grenada  of  1793 
and  1794.  It  is  fully  as  fatal,  as  rapid,  and  as 
insidious.  Its  origin,  as  far  as  it  has  been  ascer- 
tained by  the  gentlemen  I  have  mentioned,  seems 
to  be  similar.  A  ship  arrived  about  the  begin- 
ning of  July  or  end  of  June  from  Liverpool,  after 
touching  at  Surrinam.  The  filth  on  board,  occa- 
sioned by  a  cargo  of  horses,  and  the  extreme  neg- 
lect of  the  officers  and  crew,  was  such  as  beggars 
description." 

Sep.  Medical  Repository,  vol.  5,  page  229 


150  Report  on  Yellow  Fever. 

These  facts,  thus  presented  by  Dr.  Chisholm 
himself,  form  a  luminous  and  instructive  com- 
mentary on  his  former  opinion,  which  he  had 
published  with  great  confidence,  and  which  has 
been  implicitly  adopted  and  acted  on  by  the  con- 
tagionists  in  the  United  States.  In  1793,  he  pro- 
nounced the  malignant  disease  of  Grenada,  which, 
as  was  observed  before,  he  believed  to  have  been 
imported  from  the  coast  of  Africa,  a  "  novapestis" 
a  peculiar,  original,  foreign  pestilence,  recently 
generated  and  utterly  unknown  before,  endued 
with  a  new  and  distinct  character,  possessing  new 
powers  of  devastation,  and  capable  of  propagating 
itself  by  contagion  throughout  the  world.  As  he 
considered  it  to  have  been  engendered  on  board  of 
the  Hankey,  in  consequence  of  the  accumulation 
of  filth,  the  crowding  of  a  great  number  of  persons 
within  a  small  space,  and  the  heat  of  the  atmos- 
phere in  which  the  vessel  was  immersed  ;  he  must 
have  ascribed  whatever  peculiarity  he  supposed  it 
to  possess,  to  the  peculiar  state  of  the  air  on  the 
coast  of  Africa  ;  for  he  did  not  pretend  to  derive 
it  originally  from  the  inhabitants  of  Africa,  or  any 
modification  of  contagion.  No  other  circumstance 
of  the  case,  therefore,  except  some  unknown  sin- 
gularity of  the  African  atmosphere,  could  occa- 
sion this  alleged  instance  of  the  generation  of 
pestilence  in  a  ship  to  differ  from  other  cases  in 
which  malignant  fevers  are  produced  in  filthy, 


Report  on  Yellow  Fever,  151 

crowded  and  unventilated  vessels,  in  hot  climates 
or  during  hot  seasons.  But  in  the  year  1800, 
while  the  flames  of  the  Boullam  disease  lighted  up 
in  1793,  were  still  raging  far  and  wide,  and  des- 
troying the  people  of  the  West-Indies  and  of  the 
American  continent,  he  finds  another  "  nova pes- 
tis,"  generated  in  a  ship  from  England,  which  had 
touched  at  Surrinam,  and  had  become  very  filthy 
from  a  cargo  of  horses  ;  and  what  is  wonderful, 
he  finds  this  pestilence,  thus  originating  in  a  ship 
from  England,  possessing  features,  almost  with- 
out  exception,  precisely  those  of  the  malignant, 
pestilential  fever  of  Grenada,  of  1793  and  1794  ; 
fully  as  fatal,  as  rapid,  and  as  insidious. — It  appears 
then  that  the  facts  advanced  by  Dr.  C.  in  the  lat- 
ter case  (even  admitting  those  concerning  the 
Hankey  to  be  true)  instead  of  supporting  his  doc- 
trine of  novelty  and  peculiarity  in  the  fever  of 
Boullam,  go  too  far  for  his  purpose,  and  establish 
the  general  principle,  that  filthy,  crowded,  and 
unventilated  vessels,  immersed  in  a  certain  degree 
of  heat  and  dampness,  may  generate  malignant 
fever  in  all  parts  of  the  world  where  such  circum- 
stances are  found, — which  is  precisely  the  prin- 
ciple for  which  the  advocates  of  local  and  domestic 
origin  have  always  contended. 

As  to  Dr.  C.'s  opinion  of  the  contagiousness  of 
these  fevers,  it  rests  upon  the  same  vague  and 
delusive  foundation  with  the  popular,  or  rather 


152  Report  on  Yellow  Fever. 

vulgar  inference  of  contagion,  in  all  cases  where  a 
disease  attacks  a  great  number  of  persons  in  the 
same  vicinity  ;  which  has  been  sufficiently  refu- 
ted in  a  former  part  of  this  Report. 


SOME 

REMARKS 

ON 

THE  IMPORTANCE  OF  THE  STOMACH 

AS    A 

CENTRE  OF  ASSOCIATION, 

A  SEAT  OP  MORBID  DERANGEMENT, 

AND  A  MEDIUM 

OP  THE 

OPERATION  OF  REMEDIES 

IN 

MALIGNANT 
DISEASES. 


U 


TO 

BENJAMIN  MOSELET,  M.  D.  &c. 

LONDON. 


Sir,     v 

I  HAD  long  known  that  my  late  Brother 
considered  himself  as  extremely  fortunate  in  hav- 
ing established  an  epistolary  intercourse  with  the 
Author  of  the  celebrated  work  on  "  Tropical  Dis- 
eases;" and  that  he  cherished  that  intercourse  with 
peculiar  interest. 

It  was  not,  however,  until  after  his  lamented 
decease,  that  I  had  an  opportunity  of  examining 
such  portions  of  his  foreign  correspondence  as  he 
had  preserved.  Of  these  I  found  the  letters  from 
Yourself  among  the  most  numerous.  Nor  was 
their  number  the  only  circumstance  which  attract- 
ed my  attention.  The  urbanity  and  friendliness 
of  their  style  ;  the  respect  which  they  manifested 
for  my  Country,  and  for  its  literature  and  science ; 
and  the  liberal  zeal  for  the  promotion  of  general 
knowledge,  and  especially  for  the  improvement 
of  Medicine,  which  they  every  where  expressed, 
could  not  fail  to  afford  me  high  gratification,  not. 
only  as  a  Brother,  but  also  as  an  American,  and  a 
friend  to  human  happiness. 


[     156     ] 

Permit  me,  Sir,  by  prefixing  your  Name  to  the 
following  Essay,  to  discharge,  as  far  as  I  am  able, 
a  debt  on  behalf  of  the  Dead,  and  to  testify  the 
respect  and  gratitude  with  which  I  am, 

Your  obedient  Servant, 

THE  EDITOR. 
Princeton,  New- Jersey, 
January  3d,  1814. 


SOME  REMARKS,  &c. 


IN  a  former  paper  I  undertook  to  lay  before  the 
public  some  "  Cursory  Observations  on  that  Form 
of  Pestilence  called  Yellow  Fever."  In  an  attempt 
to  pursue  the  analogy  between  febrile  miasmata 
and  poisons,  I  endeavoured  to  prove  that  the  for- 
mer are  commonly  received  into  the  stomach  by 
the  swallowing  of  saliva  in  which  they  had  been 
lodged ;  and  that  by  coming  in  contact  with  its  in- 
ternal surface,  they  produce  the  affections  of  that 
organ  and  of  the  upper  intestines,  which  are  fre- 
quently indicated  by  the  symptoms  of  yellow  fe- 
ver, and  afterwards,  in  fatal  cases,  laid  open  to 
view  by  dissection. 

The  phenomena  of  hydrophobia,  and  particular 
ly  those  of  two  cases  which  occurred  in  this  city, 
and  are  related  at  p,  73  and  75  of  the  Medical 


158     Remarks  on  the  Sympathy  of  the  Stomach. 

Repository,  vol.  5th,  have  induced  a  change  of  my 
opinion  as  to  the  mode  of  operation  of  febrile 
miasmata  on  the  stomach,  and  a  conviction  of  the 
necessity  of  referring  many  such  appearances  of 
derangement  in  that  organ  to  the  influence  of  a  law 
of  animal  nature,  which  seems  to  bear  a  very  in- 
teresting relation  to  the  theory,  prevention  and 
treatment  of  malignant  fevers.  To  correct  the 
mistake  ;  to  state  what  now  appears  to  be  a  more 
accurate  view  of  the  subject ;  and  to  point  out 
some  of  the  important  and  practical  consequences 
which  are  supposed  to  result  from  this  opinion, 
are  the  objects  of  this  paper. 

The  cases  of  hydrophobia  just  referred  to,  pre- 
sented complete  examples  of  malignant  fever. 
The  mode  of  accession;  the  febrile  symptoms;  the 
progressive  extension  of  disease  from  a  few  to 
many  parts  of  the  system,  till  at  length  all  the  im- 
portant organs  were  deeply  involved ;  the  gradual 
and  uninterrupted  exhaustion  of  the  principle  of 
life,  and  the  period  of  the  fatal  termination,  all  cor- 
responded exactly  to  this  character.  The  vomit- 
ing of  black  matter*  in  one  instance,  and  the  yel- 

*  I  am  aware  that  this  symptom  may  be  ascribed,  at  the 
first  view,  to  the  large  and  frequent  doses  of  tincture  of 
cantharides  prescribed  in  that  case.  The  short  space  of 
time,  however,  in  which  the  black  vomiting  came  on  after 
the  first  doses,  and  the  total  absence  of  all  signs  of  the  more 
usual  effects  of  that  agent  on  the  system,  compel  me  to  reject 
the  opinion. 


Remarks  on  the  Sympathy  of  the  Stomach.     159 

lowness  of  the  skin  in  the  other,  after  death,  were 

But  admitting,  for  argument's  sake,  that  this  instance  of 
black  vomiting  and  of  disorganization  of  the  stomach,  was 
the  consequence  of  using  the  remedy  in  question ;  it  is  well 
known  that  the  vomiting  of  similar  matter,  as  well  as  unequi- 
vocal appearances  of  inflammation  and  derangement  of  Uie 
stomach  after  death,  are  frequently  observed  in  cases  of  hy- 
drophobia. 

Mr.  John  Hunter  informs  us,  that  in  the  examination  of  the 
bodies  of  those  who  have  died  of  hydrophobia,  "  an  appear- 
ance has,  in  general,  been  seen  on  the  inner  coats  of  the  sto- 
mach, near  the  cardia,  similar  to  what  is  found  in  the  bodies 
of  persons  who  have  had  slight  inflammation,  that  is,  a  greater 
number  of  red  vessels  with  small  streaks  of  red  blood.  In 
some  instances  there  has  been  an  increased  vascularity  of  the 
pia  mater,  or  slight  watery  effusion  on  the  surface  of  the  brain. 
In  some  dogs  that  died  of  the  disease,  the  appearances  upon 
the  inside  of  the  stomach  were  similar  to  what  have  been  al- 
ready described;  but  there  was  no  unusual  fulness  discovered 
in  the  vessels  of  the  brain,  or  its  membranes." — Transactions 
of  the  Society  for  the  Improvement  of  Medical  and  Chirurgica? 
Knowledge,  vol.  i,  page  311. 

Dr.  Baillie  observes  (Morbid  Anatomy,  p.  G8,)  that  "  in 
opening  the  bodies  of  persons  who  have  died  from  hydropho- 
bia, the  inner  membrane  of  the  stomach  is  frequently  found 
inflamed  at  the  cardia  and  its  great  end." 

Authorities  in  proof  of  this  condition  of  the  stomach,  found 
after  death  from  hydrophobia,  might,  if  it  were  necessary,  be 
multiplied  to  any  extent.  Many  likewise  might  be  adduced 
of  the  discharge  of  a  dark  coloured  matter,  by  vomiting,  to- 
wards the  close  of  that  disease,  and  where  nothing  had  been 
taken  which  was  calculated  to  induce  inflammation  and  its 
consequences. 


160     Remarks  on  the  Sympathy  of  the  Stomach. 

sufficient  to  impress  the  minds  of  all  who  had  been 
accustomed  to  see  that  form  of  malignant  disease 
which  has  so  often  prevailed  in  the  cities  of  the 
United  States  for  the  last  ten  years. 

The  analogies  between  hydrophobia  and  malig- 
nant fever  have  been  so  ably  exhibited  by  Dr. 
Rush,*  that  it  is  unnecessary  for  the  present  pur- 
pose further  to  prosecute  that  subject.  Of  the 
various  points  of  similarity  between  them,  which 
he  endeavours  to  establish  by  a  recurrence  to  facts, 
none  seems  to  be  more  important  and  convincing 
than  the  condition  of  the  stomach  and  other  por- 
tions of  the  alimentary  canal,  as  well  as  of  several 
other  viscera,  when  laid  open  to  inspection  by  the 
dissection  of  bodies  dead  of  these  diseases.  If  the 
poison  of  a  mad  dog  producing  hydrophobia  were 
to  gain  admittance  into  the  body  through  the  ali- 
mentary canal,  as  is  supposed,  with  great  proba- 
bility, in  respect  of  febrile  miasmata,  the  similar 
disorganization  of  that  canal,  and  especially  of  the 
stomach  and  duodenum,  to  what  is  discovered  by 
dissection,  after  cases  of  malignant  fever,  would 
not  so  pointedly  demand  attention  nor  offer  in- 
struction. Every  person  would  explain  the  ap- 
pearances by  referring  them  to  the  primary  opera- 
tion of  a  poison  coming  in  contact  with  this  irrita- 
ble surface.     But  when  we  find  effects  so  exactly 

*  Medical  Inquiries  and  Observations,  vol.  v,  p.  211. 


Remarks  on  the  Sympathy  of  the  Stomach.     161 

similar  arising  from  different  kinds  of  noxious- 
matter,  conveyed  into  the  system  by  different  pas- 
sages, one  of  which  is  known  to  be  often  at  a  great 
distance  from  the  parts  which  exhibit  this  morbid 
derangement  after  death  ;  will  it  not  follow  that 
such  parts  possess,  in  an  extraordinary  degree,  the 
property  of  attracting  and  fixing  disease  in  them- 
selves, with  the  effect  of  diffusing  it  afterwards,  as 
will  be  presently  seen,  to  other  parts  of  the  body  ? 

This  wonderful  property  is  possessed  by  the 
stomach,  and  some  other  portions  of  the  aliment- 
ary canal,  in  a  degree  much  beyond  the  other 
parts  of  the  body.  The  importance  of  the  sto- 
mach to  animal  life  may  be  inferred  from  its  being 
much  more  universally  found  in  the  structure  of 
animals  than  the  brain,  heart  and  lungs,  and  from 
the  deprivation  of  it  being  much  more  universally 
and  speedily  fatal  than  that  of  any,  or  all  of  those 
vital  viscera.  In  a  state  of  health,  the  functions  of 
the  stomach,  as  the  principal  organ  of  assimilation, 
will  give  it  a  high  rank  among  the  pails  of  the  sys- 
tem which  support  life.  But  it  is  in  diseases  that 
its  principal  powers  and  relations  are  unfolded  to 
view.  In  fevers  it  is  probably,  in  most  instances, 
the  first  part  affected,  as  it  commonly  affords  the 
first  notices  of  the  approaching  mischief.  From 
its  susceptibility  of  morbid  action  by  noxious 
powers  applied  immediately  to  its  surface,  or  to 
distant  parts  of  the  body  with  which  it  maintains 


162     Remarks  on  the  Sympathy  of  the  Stomach. 

sympathetic  connection,  it  becomes  not  only  the 
introducer  of  such  action  to  the  vital  organs,  but 
a  centre  of  association,  and  an  index  ol  the  most 
interesting  circumstances  concerning  the  acces- 
sion, progress,  remission,  crisis  and  cure  of  dis- 
eases. The  extreme  mobility  of  this  viscus  would 
be  more  generally  felt  if  it  were  not  for  that  un- 
consciousness of  irritations  in  it  which  nature  has 
ordained.  Even  mustard,  pepper,  salt,  and  other 
acrid  substances,  taken  into  the  stomach,  produce 
no  sensations  except  a  pleasant  warmth,  unless 
the  large  quantity  of  them  lead  to  sickness  and 
vomiting. 

No  part  of  the  system  possesses  so  wide  a  range 
of  sympathy  as  the  stomach.  The  phenomena  of 
diseases  demonstrate  every  day  its  connection  with 
the  heart  and  arteries,  the  brain,  the  lungs,  the 
skin,  the  kidneys,  the  uterus,  &c. — The  due  un- 
derstanding and  recollection  of  these  sympathies 
is  not  only  of  great  importance  in  detecting  the 
seats,  causes  and  nature  of  diseases,  but  quite  as 
much  so  in  directing  the  means  of  cure. 

In  consequence  of  this  centrality  of  association 
and  sympathy,  the  stomach  is  subjected  to  pecu- 
liar degrees  of  injury  and  derangement  by  dis- 
eases. It  may  be  safely  affirmed,  that  no  part  of 
the  body  is  so  liable  to  disorganization  by  malig- 
nant fevers  as  the  alimentary  canal,  and  especially 


Remarks  on  the  Sympathy  of  the  Stomach.     163 

the  stomach  and  duodenum.  Morbid  dissections 
so  generally  afford  proof  of  this,  that  it  would  be 
improper  to  detain  the  reader  by  a  recital  of  par- 
ticulars. 


Such  considerations  as  these,  in  addition  to  a  great 
many  others,  seem  fully  to  support  the  doctrine  that 
fever  is  principally  a  disease  of  association,  and 
to  prove  that  the  sympathetic  theory  of  it  is  better 
adapted  than  any  hitherto  known,  to  explain  the 
various  phenomena,  and  to  point  out  the  most  ap- 
propriate and  efficacious  modes  of  treatment.  It 
affords  strong  confirmation  of  this  doctrine,  that 
the  stomach,  the  most  associable  part  of  the  sys- 
tem, is  the  first  and  principal  sufferer  from  the 
noxious  causes  which  produce  fevers  ;  and  that 
afterwards,  in  succession,  the  organs  possessing 
the  closest  sympathetic  relation  to  the  stomach, 
such  as  the  heart  and  arteries,  the  brain,  the  lungs, 
the  skin,  &c.  are,  precisely  in  the  order  of  their 
sympathy,  the  most  exposed  to  be  involved  in  this 
morbid  connection. 

The  mistake  referred  to  above,  in  my  paper 
concerning  yellow  fever,  consisted  in  adopting- 
the  opinion,  that  the  gastric  affection  in  that  dis 
ease  ought  to  be  attributed  to  the  primary  and  im- 
mediate action  of  the  febrile  poison,  swallowed 
with  the  saliva,  upon  the  inner  surface  of  the  sto- 
mach and  duodenum.     This  was  undoubtedly  a 


164     Remarks  on  the  Sympathy  of  the  Stomach. 

hasty  and  incorrect  view  of  the  subject.  The 
phenomena  of  hydrophobia,  one  of  the  most  ex- 
quisite and  deadly  forms  of  malignant  fever,  af- 
ford ample  means  of  correction.  In  this  disease, 
the  virus  received  on  any  part  of  the  external  sur- 
face of  the  body,  at  the  most  distant  point  of  the 
upper  or  lower  extremities,  after  laying"  dormant 
awhile,  like  the  miasmata  of  fevers,  though  gene- 
rally for  a  longer  time,  excites  the  stomach  into 
violent  morbid  action,  and  then,  successively,  all 
the  important  and  vital  parts  of  the  system.  The 
manner  and  degree  in  which  this  morbid  action 
disorganizes  the  texture  of  the  stomach,  and  oc- 
casionally of  the  brain  and  other  organs,  may  be 
learned  from  the  dissection  of  bodies  which  have 
died  of  hydrophobia,  as  completely  as  in  cases  of 
other  diseases  commonly  called  malignant  fevers. 

So  far  as  hydrophobia  from  canine  poison  may 
be  conceived  to  be  of  the  nature  of  malignant  fe- 
ver, the  distinction  between  the  consequences  of 
the  primary  and  secondary  modes  of  affecting  the 
stomach  by  febrile  poisons  is  either  weakened,  or 
falls  entirely  to  the  ground.  Dr.  Darwin,  whose 
theory  of  fever  will  remain  an  everlasting  monu- 
ment of  his  penetration  and  the  comprehensiveness 
of  his  views,  relies  on  that  distinction  to  explain 
the  difference  between  the  mild  and  confluent 
small* pox.  Thus  he  supposes,  "  that  in  the  dis- 
tinct small-pox  the  stomach  is  affected  secondarily 


Remarks  on  the  Sympathy  of  the  Stomach.     165 

by  sympathy  with  the  infected  tonsils  or  inoculated 
arm  ;  but  that  in  the  confluent  small-pox  the  sto- 
mach is  affected  primarily,  as  well  as  the  tonsils, 
by  contagious  matter  mixed  with  the  saliva  and 
swallowed."  With  all  possible  deference  for  such 
authority,  it  seems  to  be  difficult  to  admit  this 
doctrine  without  many  exceptions.  There  can  be 
no  doubt  that  the  inoculated  small-pox  sometimes 
proves  to  be  confluent,  where  no  suspicion  can 
exist  of  contagious  matter  being  admitted  into  the 
stomach,  and  primarily  or  immediately  affecting 
that  organ.  Would  not  Dr.  Darwin  have  been 
nearer  the  truth  if  he  had  contended  that  the  force 
of  morbid  action,  which  is  sympathetically  con- 
veyed from  the  inoculated  part  to  the  stomach, 
and  thence  extended,  by  association,  to  other  parts 
of  the  system,  may,  according  to  constitutional 
and  other  circumstances,  be  sufficiently  diversified 
to  produce  all  the  varieties  of  the  distinct  and  con- 
fluent disease  ? 

The  phenomena  of  hydrophobia  from  canine 
poison,  of  the  diseases  produced  by  the  bites  of 
certain  serpents,  and  of  confluent  small-pox  when 
it  happens  to  be  the  consequence  of  inoculation 
(all  which  may  be  regarded  as  so  many  instances 
of  malignant  fever,)  serve  thus  to  show,  in  a  con 
vincing  light,  the  wonderful  mobility  and  associa- 
bility  of  the  stomach,  as  well  as  of  the  other  vital 
organs  with  which  it  is  especially  connected  by 


166     Remarks  on  the  Sympathy  of  the  Stomach, 

sympathy,   and  thereby  to  lay  a  broad  foundation 
for  the  sympathetic  theory  of  fever. 

The  doctrine  of  fever,  therefore,  which  appears 
to  be  most  consistent  with  the  phenomena,  so  far 
as  they  hitherto  have  been  observed,  is  this  : — 
Certain  noxious  powers,  called  miasmata,  conta- 
gions and  poisons,  find  admittance  into  the  system 
through  the  mouth  and  nose,  or  the  pores  of  the 
skin,  or  they  are  inserted  by  the  bite  of  a  rabid  or 
venomous  animal.  Whether  miasmata  and  conta- 
gions, entering  by  the  mouth,  exert  their  action 
chiefly  on  the  lungs  or  stomach,  cannot  yet  be 
certainly  decided.  It  is  not  improbable  that  dif- 
ferences in  the  ensuing  disease  may  often  arise 
from  the  various  degrees  of  susceptibility  in  the 
several  organs  which  give  reception  to  the  noxious 
matter.  But  whatever  be  the  mode  or  place  of 
entrance,  the  noxious  matter,  after  a  longer  or 
shorter  time,  excites  the  system  to  a  state  of  ac- 
tion which  is  morbid  both  in  kind  and  degree. 
The  stomach,  the  most  moveable  and  associable  of 
all  the  organs  of  the  animal  body,  is  the  first  to 
experience  this  excitement  in  itself — the  most 
adapted,  from  its  extraordinary  powers  of  sympa- 
thy, to  extend  it  to  other  viscera — and  the  most 
liable  to  sustain  the  burthen  of  the  disease,  and  to 
undergo  the  most  fatal  disorganization.  To  the 
heart  and  arteries,  to  the  brain,  to  the  lungs,  to  the 
skin,  and  occasionally  to  many  other  important 


Remarks  on  the  Sympathy  of  the  Stomach.     167 

parts  of  the  system,  is  this  morbid  excitement 
communicated  by  means  of  the  associative  influ- 
ence of  the  stomach.  Hence  all  the  variety  of 
congestion,  inflammation,  effusion,  engorgement, 
gangrene,  and  other  modes  of  derangement  which 
dissection  exhibits  in  the  stomach,  intestines, 
brain,  lungs,  and  other  viscera  of  such  as  die  of 
malignant  fevers. 

If  this  view  of  the  nature  of  febrile  diseases  be 
just,  it  will  serve  to  direct  the  attention  of  the  phy- 
sician, in  an  especial  manner,  to  certain  objects 
respecting  the  prevention  and  treatment  of  them, 
which  cannot  be  too  studiously  regarded. 

Admitting  that  morbid  action  in  febrile  diseases 
is  at  first  the  result  of  a  poison  locally  applied ; 
that  this  action  begins  in  certain  organs,  often  pri- 
marily and  chiefly  in  the  stomach,  not  so  much  on 
account  of  the  local  reception  of  the  poison  there, 
as  because  that  viscus  possesses  an  extraordinary 
portion  of  susceptibility  of  excitement ;  that  this 
action,  so  implanted  in  the  stomach,  the  centre  of 
association  and  sympathy,  is  gradually  extended 
to  other  viscera  with  which  it  has  principal  sym- 
pathetic relations,  such  as  the  heart,  brain,  lungs, 
&c. ;  that  this  action  must  necessarily,  in  most 
cases,  commence  with  a  nascent  feeble  existence, 
and  only  by  degrees  acquire  growth,  strength  and 
stability  :  that  when  once  the  force  of  habit  is  join- 


168     Remarks  on  the  Sympathy  of  the  Stomach. 

ed  to  the  original  violence  with  which  this  action 
began,  the  means  of  subduing  it  will  become  every 
hour  more  precarious  and  difficult ;  and,  finally, 
that  this  action  of  organs  so  tender  and  vital,  if  al- 
lowed to  proceed,  will  often,  in  a  few  days,  render 
the  system  unfit  to  sustain  life,  and  produce  those 
appearances  of  disorganization  which  dissection 
exhibits  after  death ; — it  follows,  from  a  due  con- 
sideration of  these  circumstances,  that  the  first 
object  of  the  physician  should  be  to  arrest  this 
diseased  action  in  the  earliest  hours  of  its  forma- 
tion, before  a  more  extended  operation,  time  and 
habit,  shall  have  fixed  its  possessions  of  the  sys- 
tem, and  that  he  should  regard  all  subsequent  at- 
tempts as  comparatively  feeble  and  uncertain. 

Although  it  is  not  my  design  to  deliver  any 
sreneral  account  of  the  treatment  of  febrile  dis- 
eases,  it  will  not  be  improper  to  glance  at  some  of 
the  remedies  whose  application  depends  upon  the 
principles  which  I  have  attempted  to  explain.  In 
this  view  of  the  subject,  the  most  direct  methods 
of  arresting  febrile  action  are,  1st.  To  excite  a 
new  action  subversive  of  the  exist*  ig  one  in  the 
organ  originally  and  principally  affected,  and  in 
such  as  are  associated  with  it ;  and,  2dly.  To  di- 
vert morbid  action  from  an  important  or  vital  part, 
by  exciting  a  sufficient  degree  of  it  in  some  other 
part  less  essential  to  life. 


Reynarks  on  the  Sympathy  of  the  Stomach.     169 

As  an  example  of  the  first  class,  it  is  proper  to 
mention  the  efficacy  of  emetics  at  the  commence- 
ment of  febrile  diseases,  the  use  of  which  is  sanc- 
tioned by  immemorial  experience.  The  evacua- 
tion they  procure,  though  often  confessedly  im- 
portant, constitutes  but  a  small  proportion  of  the 
advantage  which  is  found  to  result.  Sydenham 
perceived  this  effect  with  his  usual  sagacity,  with- 
out thoroughly  understanding  the  cause.  "  When 
I  have  happened,"  says  he,  "sometimes  carefully 
to  examine  the  matter  thrown  up  by  vomit,  and 
found  it  neither  considerable  in  bulk,  nor  of  any 
remarkable  bad  quality,  I  have  been  surprized 
how  it  should  happen  that  the  patient  has  been  so 
much  relieved  thereby  ;  for  as  soon  as  the  opera- 
tion was  over,  the  severe  symptoms,  viz.  the  nau- 
sea, anxiety,  restlessness,  deep  sighing,  blackness 
of  the  tongue,  &c.  usually  abated  and  went  off,  so 
as  to  leave  the  remainder  of  the  disease  tolerable."* 
His  annotator  Wallis,  properly  remarks  on  this 
passage,  that  Sydenham  "  was  not  aware  of  the 
sympathetic  affections  which  take  place  in  the  con- 
stitution, nor  knew  that  an  extremely  small  portion 
of  morbid  matter  could  produce  effects  so  sudden 
and  surprising,  from  local  action,  so  as  to  derange 
the  whole  system."  It  will  be  apparent  to  every 
body,  that  this  morbid  action  in  the  stomach, 
whether    primarily    or    sympathetically   excited, 

*  Work?,  vol.  i,  p.  34  of  Wallis's  edition. 

y 


170     Remarks  on  the  Sympathy  of  the  Stomach. 

while  yet  only  beginning,  must  be  comparatively 
unsettled  and  undetermined  in  its  operation  ;  and 
that  this  offers  the  golden  opportunity,  perhaps 
never  to  return,  of  creating  a  different  and  more 
healthy  action  by  means  of  emetics,  and  thereby 
of  rescuing  the  patient  from  the  danger  which 
awaits  him.  And  at  the  same  time  it  will  be 
equally  apparent,  that  if  emetics  be  exhibited  after 
certain  degrees  of  morbid  excitement  shall  have 
been  actually  formed  and  confirmed  in  the  sto- 
mach, that  they  will  not  only  be  entirely  incompe- 
tent to  dislodge  the  disease,  but  will  aid  and  hasten 
that  disorganizing  process  which  renders  the  sys- 
tem incapable  of  life. 

Sudorifics  may  be  properly  taken  as  an  example 
of  the  remedies  which  operate  by  diverting  mor- 
bid action  from  an  important  and  vital  to  a  less 
important  part.  It  has  been  often  supposed  that 
they  produce  their  beneficial  effects  by  causing  the 
discharge  of  certain  noxious  fluids,  which,  being 
retained  in  the  system,  would  have  caused  a  con- 
tinuance of  the  febrile  commotion.  This  opinion 
is  opposed  by  a  number  of  difficulties,  which  it 
seems  impossible  to  remove  or  surmount.  On 
the  contrary,  the  referring  of  the  efficacy  of  sudo- 
rifics to  a  revulsion  of  excitement  from  internal 
organs  to  the  skin,  is  conformable  to  known  laws 
of  the  animal  economy,  and  supported  by  facts 
which  fall  under  dailv  observation. 


Remarks  on  the  Sympathy  of  the  Stomach.     171 

The  plan  of  curing  diseases  by  transfer  or  re- 
vulsion of  excitement  from  one  part  of  the  system, 
and  fixing  it  in  another,  includes  a  great  propor- 
tion of  our  most  powerful  remedies,  and  opens  a 
wide  field  of  future  discovery  and  improvement. 
The  effects  of  mercury  in  producing  ptyalism— 
of  blisters  in  inflaming  and  vesicating  the  skin, 
and  exciting  a  strangury,  of  sinapisms,  other  rube- 
facients, and  of  many  other  articles  operating  on 
similar  principles,  afford  examples  of  this  revulsion 
of  excitement.  Though  it  is  not  requisite  that 
these  remedies  should  be  always  employed,  like 
emetics,  in  the  forming  stage  of  the  disease,  it  is 
certainly  expedient  to  bring  many  of  them  early 
into  use.  This  is  particularly  the  case  with  mer- 
cury. According  to  the  principles  of  association, 
febrile  action  will  be  more  easily  subdued  in  its 
earlier  than  more  advanced  stages ;  hence  the  mer- 
curial disease  will  be  efficacious  in  destroying  the 
original  one,  in  proportion  to  the  expedition  with 
which  it  is  excited.  It  is  probable,  likewise,  that 
the  mercurial  action  will  be  more  readily  introdu- 
ced in  the  beginning  of  the  disease,  when  morbid 
sympathies  are  few,  and  feebly  catenated,  than  at  a 
later  period,  when  all  the  important  viscera  are  la- 
bouring under  excess  of  stimulus,  and  when  time 
and  habit  have  confirmed  the  strength  of  the  nox- 
ious association.  Some  degree  of  this  reasoning- 
will,  doubtless,  be  applicable  to  all  the  articles 
which  belong  to  this  head.     In  the  case  now  un- 


172     Remarks  on  the  Sympathy  of  the  Stomach. 

tier  consideration,  the  causes  of  diseases,  and  the 
remedies  for  them,  operate  on  the  system  upon  the 
same  principle.  It  is  by  excessively  concentra- 
ting excitement  in  certain  organs,  and  by  rob- 
bing others  of  their  due  share,  that  such  noxious 
powers  induce  disease.  By  pursuing  an  analogous 
course,  and  soliciting  excitement  back,  again  from 
the  diseased  parts,  in  order  to  fix  it  in  others  less 
essential  to  life,  the  physician  (differing  chiefly 
from  the  morbid  cause  in  the  parts  to  which  he 
applies  the  stimulating  agent)  imitates  the  proce- 
dure of  those  noxious  principles  which  are  most 
inimical  to  life. 

The  doctrine  of  the  leading  agency  of  the  sto- 
mach in  the  establishment  and  extension  of  the 
morbid  motions  called  febrile,  satisfactorily  ex- 
plains the  effects  of  emotions  of  the  mind,  and  es- 
pecially of  terror,  in  bringing  on  diseases,  and 
imparting  to  them  a  malignant  character.  What- 
ever weakens  the  stomach  will  expose  it  to  the 
attack  of  febrile  poison.  No  part  of  the  body  ex- 
hibits more  intimate  connection  with  the  mind  than 
that  organ.  No  other  part  has  its  functions  so  im- 
mediately affected  by  mental  emotions,  as  is  often 
observed  in  the  sudden  loss  of  appetite  and  sus- 
pension of  digestion  by  the  arrival  of  joyful  or  af- 
flicting intelligence.  The  consequences  of  this 
close  connection  are  often  pernicious  in  the 
seasons  of  mortal  epidemics.     Every  individual. 


Remarks  on  the  Sympathy  of  the  Stomach.     173 

at  such  times,  must  be  presumed  to  be  more  or 
less  under  the  influence  of  the  reigning  noxious 
power.  Terror  is  apt  to  start  up  and  assail  the 
mind  from  trifling  as  well  as  substantial  causes  of 
apprehension.  The  stomach  being,  as  has  been 
seen,  the  chief  recipient  and  propagator  of  moibid 
action,  and  this  morbid  action  being  most  likely 
to  intrude  and  fix  itself  when  that  viscus,  from  any 
cause,  is  deprived  of  its  accustomed  tone  ;  it  clear- 
ly results  that  terror  may  operate  in  seasons  of 
malignant  epidemics  as  a  powerful  and  destructive 
exciting  cause.  Experience  and  observation  con- 
firm the  opinion  suggested  by  reasoning.  It  is 
often  popularly  remarked,  that  such  as  are  most 
fearful  of  malignant  diseases  are  most  apt  to  be 
attacked  by  them.  There  can  be  no  doubt  that 
this  opinion  is  founded  on  fact.  Many  of  the  vague 
and  mistaken  accounts  of  the  propagation  of  ma- 
lignant diseases  by  contagion,  admit  of  an  easy 
explanation  on  this  ground.  A  system  impreg- 
nated with  the  prevailing  virus,  but  capable  of 
sustaining  it,  without  injury,  so  long  as  the  equi- 
librium of  excitement  can  be  exactly  preserved  in 
the  several  parts  of  the  body,  may  be  supposed  to 
be  suddenly  struck  with  terror  at  the  sight  of  some 
frightful  spectacle,  or  at  the  recital  of  some  alarm- 
ing story.  What  will  be  the  consequence  ?  The 
well-adjusted  balance  of  excitement  is  immediately 
lost ;  the  stomach,  deprived  of  its  tone  by  mental 
agitation,  is  left  a  prey  to  the  insidious  destroyer 


174     Remarks  on  the  Sympathy  of  the  Stomach. 

which  had  been  long  lying  in  wait  for  such  an 
opportunity  of  intruding.  This  principle  will  go 
far  in  explaining  many  pretended  facts  concerning 
the  contagiousness  of  Asiatic  plague  and  the  yel- 
low fever.  It  is  asserted  that  contact  is  the  surest 
mode  of  communicating  the  contagion  of  the 
plague.  It  may  be  said,  with  equal  truth,  that 
contact  is  the  surest  mode  of  exciting  terror  in  the 
person  exposed  to  that  kind  of  intercourse.  If  the 
apprehension  of  contagion  floating  in  the  atmos- 
phere, and  casually  applied  to  the  bodies  of  men, 
be  a  source  of  alarm,  what  must  be  the  consterna- 
tion of  such  as  believe  themselves  to  receive  im- 
mediately from  the  persons  of  the  sick,  the  undi- 
luted infection  they  so  much  dread  ?  It  is  well 
known  that  persons  who  have  imbibed  the  poison 
of  pestilential  epidemics  often  escape  injury,  until 
exposure  to  cold  or  fatigue,  the  effects  of  intempe- 
rance, indigestion,  he.  coming  in  aid  of  that  poi- 
son, suddenly  induce  the  disease.  There  is  good 
reason  to  rank  terror  among  the  most  potent  of 
such  occasional  causes.  Among  an  ignorant  and 
superstitious  people,  the  danger  of  actual  contact 
will  naturally  be  much  more  highly  rated  than  that 
of  any  species  of  poisonous  articles  diffused  in  the 
air.  This  impression  will  be  strengthened  by  the 
recollection  of  several  diseases  communicable  by 
contact,  but  not  by  effluvia.  And  it  is  probable' 
that  a  mortal  epidemic,  by  filling  the  minds  of  the 
weak  with  frightful  impressions,  especially  when 


Remarks  on  the  Sympathy  of  the  Stomach.     175 

these  impressions  are  heightened  by  an  accidental 
contact  of  the  sick,  is  rendered  much  more  des- 
tructive to  the  community  through  the  associative 
operation  of  fear,  which  thus,  under  the  mask  of 
contagion,  exerts  a  fatal  influence  on  the  system, 
through  the  medium  of  the  stomach.  All  the  re- 
signation that  fatalism  can  boast,  in  Mahometan 
countries,  is  insufficient  to  shield  the  mind,  and 
the  group  of  vital  organs  connected  with  it  by 
sympathy,  from  the  ravages  of  terror  and  despair. 

The  noxiousness  of  terror  seems  to  admit  of 
illustration  from  the  effects  of  intemperance  in 
debilitating  the  stomach,  and  thereby  inviting  the 
attack  of  febrile  action.  The  observation  is  fami- 
liar to  every  person,  that  the  invasion  of  malignant 
diseases  is  more  frequent  and  violent  after  a  fit  of 
drunkenness.  That  the  stomach  is,  in  this  case, 
the  first  and  principal  sufferer,  will  not  be  denied. 
But  the  condition  of  this  organ  is  not  rendered 
much  more  unfit  for  the  performance  of  its  func- 
tions by  a  debauch,  than  by  the  overwhelming 
operation  of  terror. 

The  use  of  mild  corroborant  remedies,  during 
the  prevalence  of  malignant  epidemics,  for  the  pur- 
pose of  securing  the  system  against  the  approach 
of  febrile  action,  by  supporting  the  powers  of  the 
stomach,  is  strongly  enjoined  by  the  view  which 
is  here   presented  of  the  functions  and  irritability 


176     Remarks  on  the  Sympathy  of  the  Stomach. 

of  that  organ.  The  efficacy  of  such  remedies  is 
also  established  on  the  ground  of  experience. 
The  daily  use  of  a  small  quantity  of  Peruvian  bark 
to  fortify  the  stomach,  and,  through  the  medium 
of  that,  the  whole  system,  against  the  fevers  of  tro- 
pical regions,  has  preserved  multitudes  from  the 
attack  which  otherwise  awaited  them.  Is  is  be- 
lieved that  no  instance  of  the  failure  of  it,  if  pro- 
perly taken  and  continued,  stands  upon  record. 

The  sympathetic  theory  of  fever  affords  the  ea- 
siest solution  of  the  problem  of  its  spontaneous 
cure.  The  healthy  action  and  associations  of  the 
several  organs  of  the  body  are  more  natural,  pow- 
erful and  durable,  than  such  as  are  morbid,  and,  of 
consequence,  have  an  incessant  tendency  to  recur, 
and  regain  their  force  whenever  the  excitement  of 
the  disease  proves  too  feeble  to  disorganize,  or  ex- 
tinguish the  life  of  the  affected  parts. 

The  same  theory  satisfactorily  explains  the  cure 
of  diseases  by  a  great  variety  of  different,  and  often 
opposite  remedies.  If  evacuants  be  employed,  the 
sympathetic  relations  of  all  the  important  organs 
to  one  another  will  frequently,  in  milder  cases, 
render  it  almost  a  matter  of  indifference  whether 
this  or  the  other  mode  of  evacuation  shall  have 
been  preferred.  And  it  is  equally  plain,  that  to 
excite  a  new  action  in  any  part,  subversive  of  the 
existing  morbid  one,  or  to  produce  a  revulsion  of 


Remarks  on  the  Sympathy  of  the  Stomach.     177 

excitement  from  an  organ  of  importance  to  another 
less  essential  to  life,  an  hundred  different  remedies 
may  be  used  without  leading  to  any  material  va- 
riation in  the  result.  Still,  however,  it  should  be 
always  remembered,  that  there  is  a  highest  grade 
in  the  appropf  iateness  of  the  selection,  as  well  as 
in  the  efficacy  of  remedies,  which  the  enlightened 
physician  will  incessantly  endeavour  to  approach. 

An  attention  to  the  condition  of  the  stomach  has 
been  always  known  to  physicians  as  a  leading  part 
of  their  duty  in  the  treatment  of  malignant  diseases. 
The  reason  and  necessity  of  this  will  more  fully 
appear  if  it  be  granted,  as  has  been  attempted  to 
be  shown,  that  this  organ,  from  its  peculiar  and 
unequalled  susceptibility,  is  the  chief  introducer 
and  propagator  of  febrile  action,  the  most  apt  to 
become  the  subject  of  its  disorganizing  violence, 
and,  as  a  medium  of  the  operation  of  remedies,  its 
most  powerful  counter- agent  and  destroyer.  And 
hence  it  will  be  obvious  that  the  proper  manage- 
ment of  this  noble  organ,  and  of  its  band  of  noble 
associates  in  sympathy,  is  of  primary,  essential, 
and  decisive  importance,  in  the  prevention  and 
treatment  of  malignant  fevers. 


AN 


ATTEMPT 


TO    DEDUCE    A 


NOMENCLATURE 


OP    CERTAIN 


FEBRILE  AND  PESTILENTIAL  DISEASES 


FROM 


THE  ORIGIN  AND  NATURE 


OP    THEIR 


REMOTE  CAUSE, 


TO 


JOHN  WARREN,  M.  D. 

PROFESSOR    OF     ANATOMY,    IN    THE     UNIVERSITY     OF 
CAMBRIDGE,    MASSACHUSETTS. 


Dear  Sir, 

THE  obligation  of  my  Family  to  You  is  of  long- 
standing. More  than  thirty- six  years  ago,  when 
my  eldest  Brother  fell  a  sacrifice  to  exposures  and 
hardships  encountered  in  the  service  of  his  Coun- 
try, he  enjoyed  all  the  tender  assiduities  of  your 
friendship  ;  expired  in  your  arms  ;  and  was  hon- 
oured by  You  in  his  death. 

Be  not  surprised  that  the  remembrance  of  such 
a  fact,  gratefully  cherished,  should  suggest,  in  col- 
lecting the  writings  of  a  younger  Brother,  of  the 
same  Family  and  Profession,  the  propriety  of  in- 
scribing some  production  of  his  pen  to  You.  Had 
it  been  possible  to  consult  Him  on  the  subject,  his 
affectionate  veneration  for  the  name  of  Warren, 
would  have  more  than  sanctioned  the  choice 
which  led  to  this  public  testimony  of  respect  and 
gratitude. 


[     182     ] 

That  You  may  long  continue  to  adorn  your 
Profession,  to  enlighten  the  students  of  the  Heal- 
ing Art,  and  to  bless  your  Country  ;  and  at  the 
close  of  a  life  equally  useful  and  happy,  may  be 
graciously  received  to  that  world,  in  which  the 
glimmerings  of  human  science,  shall  be  lost  in  the 
radiance  of  Unbounded  Knowledge,  and  the  feeble 
exertions  of  philanthropy  give  place  to  the  unfet- 
tered activity  of  perfect  and  eternal  benevolence,  is 
the  ardent  prayer  of,  ■ 

My  dear  Sir, 
Your  grateful  friend  and  servant, 


THE  EDITOR. 

Jan.  20,  1814. 


Princeton j  N.  J. ) 
4.     5 


AN  ATTEMPT,  &c, 


J.  HERE  is  a  group  of  diseases  related  to  one 
another  by  obvious  affinities,  and  essentially  dif- 
fering from  all  others,  which  do  not  appear  to  have 
been  hitherto  discriminated  with  sufficient  distinct- 
ness in  any  arrangement  of  Nosology.  It  is  not 
easy  to  determine  precisely  the  whole  number  that 
ought  to  be  admitted  into  this  natural  assemblage. 
The  Oriental  Plague,  the  Yellow  Fever  of  Ame- 
rica, with  all  the  subordinate  grades  of  Remittents 
and  Intermittents,  and  the  several  varieties  of  Ty- 
phus, are  those  which  exhibit  the  most  intimate 
relations.  Dysentery,  and  some  other  distempers 
of  warm  climates  and  seasons,  which  are  apt  to 
become  epidemic,  certainly  deserve  to  stand  in  the 
same  association.  All  these,  as  they  are  supposed 
to  be  the  effect  of  a  common  principle,  somewhat 


184    Proposal  of  a  new  Nomenclature  of  Fevers. 

modified,  which  is  properly  called  Miasma,  or  the 
effluvium  of  dead  animal  and  vegetable  substances 
undergoing  decomposition,  may  be  denominated 
Miasmatic  Diseases. 

Miasmatic  Diseases  fill  an  immense  space  in  the 
history  of  the  epidemic  and  pestilential  distempers 
which  have  always  been  the  scourge  of  the  human 
race.  From  their  peculiar  origin  and  causes  ;  from 
their  influence  on  commerce;  from  their  effects  on 
the  hospitable  and  liberal  intercourse  of  nations ; 
from  the  improvements  which  might  be  made  by 
communities  and  individuals  towards  preventing 
and  mitigating  the  prevalence  of  them,  and  on  a 
variety  of  other  accounts,  they  deserve  to  be  con- 
sidered separately  from  all  other  distempers,  and  as 
not  only  interesting  as  a  distinct  whole,  but  like- 
wise as  made  up  of  various  species,  possessing  dif- 
ferent characters,  qualities  and  degrees,  which  are 
well  worthy  of  being  analyzed,  distinguished,  and 
minutely  discussed. 

The  nomenclature  of  these  diseases  ought  to 
embrace  the  leading  facts  belonging  to  the  subject, 
and  divide  and  arrange  them  in  a  natural  method. 
This  does  not  appear  to  have  been  sufficiently 
done  in  any  of  the  systems  of  Nosology  which  are 
now  before  the  public ;  and  considering  the  de- 
clining credit  of  such  modes  of  arranging  diseases, 
the  defect  is  not  likely  to  be  soon  supplied.     It 


Proposal  of  a  new  Nomenclature  of  Fevers.     185 

would  be  inconsistent  with  the  design  and  limits 
of  these  remarks  to  inquire  generally  into  the 
merits  of  Nosology.  While  the  advantages  of  it 
in  some  respects  cannot  be  denied,  it  must  be 
granted,  on  the  other  hand,  that  it  is  liable  to 
much  abuse,  and  too  often  leads  such  as  confide 
in  it  to  content  themselves  with  a  parade  of  terms 
instead  of  substantial  knowledge.  To  inquire  in- 
to the  comparative  merits  of  the  various  plans  of 
Nosology  hitherto  published,  would  open  a  field 
still  wider,  on  which  it  is  not  intended  now  to 
enter.  The  causes,  seats,  and  especially  the 
symptoms  of  diseases,  have  been  taken  by  the 
different  writers  as  the  foundation  of  arrangement. 
Sauvages  and  Cullen,  and  most  of  the  other  no- 
sologists,  endeavour  to  discriminate  diseases  by 
their  symptoms,  and  labour  with  great  attention 
to  distinguish  such  as  are  merely  accidental,  or 
concomitant,  from  those  which  are  essential  and 
inseparable. 

It  has  been  generally  supposed  that  the  science 
of  Medicine  is  yet  too  imperfect  to  admit  of  the 
erecting  of  a  system  of  nosology  on  the  causes  of 
diseases.  The  author  of  Zoonomia,  with  that 
boldness  and  force  of  mind  which  distinguish  most 
of  his  researches,  has  ventured  to  take  the  proxi- 
mate cause  as  the  ground  of  his  classic  character. 
He  contends  that  this  mode  of  discrimination  is 
better  adapted  than  any  other,  to  enable  physicians 

2  a 


186    Proposal  of  a  new  Nomenclature  of  Fevers. 

distinctly  to  understand  the  nature  of  diseases  by 
a  comparison  of  their  essential  properties,  to  faci- 
litate the  knowledge  of  the  modes  of  treatment, 
and  to  discover  the  nature  and  proper  denomina- 
tion of  any  disease  previously  unknown. 

Instead  of  the  proximate,  the  remote  cause  is 
resorted  to  in  this  attempt  to  assign  a  distinct  cha- 
racter to  the  assemblage  of  diseases  now  under 
consideration.*  It  is  not  expected  that  the  new 
terms  which  are  here  to  be  proposed,  will  be  re- 
ceived into  professional  or  popular  use,  or,  indeed, 
that  they  will  be  well  suited  to  that  purpose.  The 
object  of  proposing  them  is  chiefly  to  produce  a 
clear  and  distinct  impression  of  that  doctrine  con- 
cerning the  origin,  nature  and  relations  of  the  dis- 

*  Dr.  Cullen  admits  (he  propriety  of  sometimes  discrimi- 
nating diseases  by  a  reference  to  their  remote  cause  in  the 
following  words :  "  Principii  quaxlam  similitudo,  morborum 
inde  in  diversis  hominibus  genitorum  similitudincm  arguit; 
ita,  quaudo  morbi  diversorum  hominum,  ex  uno  eodemque 
principio  oriantur;  quando,  etiam  principium  illud,  ad  mor- 
bum  gignendum,  in  unoquoque  necessarium  sit ;  denique, 
quando  idem  principium,  ubique  fere  ejusdem  qualitatis  et  vis 
esse  videatur,  turn  demum  morbos,  ex  ejusmodi  principio  ge- 
uitos,  ejusdem  vel  simillimae  naturae  esse,  judicare  licet." — 
Vide  Synops.  Nosolog.  Method,  p.  194. 

In  conformity  to  this,  in  his  character  of  Infermiltcnfcs,  he 
describes  them,  "  Febres,  miasmate  pallidum  ortoz"  &{C. — 
Ibid.  p.  204. 


Proposal  of  a  new  Nomenclature  of  Fevers.    187 

eases  in  question,  which  has  been  long  maintained, 
in  this  work,  and  yet  by  many  seems  to  have  been 
greatly  misunderstood.  Through  the  medium  of 
new  language,  it  is  possible  some  additional  light 
may  be  shed  on  this  intricate  subject.  If  the  re- 
mote cause  of  Miasmatic  diseases  had  been  cor- 
rectly understood,  much  of  their  prevalence  and 
ravages  might  have  been  spared,  and  much  of  the 
zeal  and  learning  wasted  in  controversy  about  the 
mode  of  their  introduction,  would  have  been  devo- 
ted to  the  more  substantial  objects  of  ascertaining 
their  nature  and  treatment. 

It  is  probable  the  truth  on  this  subject  would 
long  since  have  universally  predominated,  if  the 
doctrine  of  the  contagiousness  of  Miasmatic  dis- 
eases, and  their  exportation  and  importation  from 
one  region  of  the  globe  to  another,  had  not  been 
so  precipitately  adopted.  There  is  scarcely  any 
thing  in  the  history  of  medical  opinions  which  de- 
serves to  be  more  regretted,  which  has  done  so 
much  to  retard  the  progress  of  improvement,  or 
to  close  mens'  eyes  against  the  light  of  truth. 
Under  the  influence  of  this  error,  the  knowledge 
of  febrile  diseases,  for  a  long  period,  was  either 
stationary  or  retrograde.  No  reference  to  conta- 
gion is  to  be  found  in  the  works  of  Hippocrates, 
Celsus,  Aretasus  or  Trallian.*     These  venerable 

*  This  is  affirmed  on  the  authority  of  Dr.  Blane  (see  his 
Observations  on  fke  Diseases  of  Seamen,  p.  217.)  as  well  ac 


188    Proposal  of  a  nexv  Nomenclature  of  Fevers. 

observers  of  nature  saw  much  of  pestilential  epi- 
demics ;  but  they  saw  nothing  of  contagion,  or  of 
the  introduction  of  such  diseases  by  importation 
from  abroad.  From  the  writings  of  Galen  it  may 
be  perceived  that,  amidst  a  multitude  of  other  spe- 
culative notions,  he  believed  in  febrile  contagion. 
From  him  it  passed  down  with  the  herd  of  copy- 
ists and  interpreters  of  his  opinions  to  the  time  of 
Fracastorius,  who  reduced  the  doctrine  to  a  more 
systematic  form,  and  contributed  much  to  its  cur- 
rency and  authority.  In  this  state  it  descended  to 
the  time  of  Dr.  Mead,  who  may  be  regarded  as 
the  great  modern  advocate  of  contagion,  whose 
learning  and  professional  eminence  have  done 
much  to  produce  that  confidence  in  the  doctrine, 
which  is  still  to  be  found  in  many  parts  of  Europe. 

The  prejudices  of  Europe  on  this  subject  are 
rapidly  losing  their  influence  in  America.  Much 
of  what  was  formerly  ascribed  to  contagion  is  now 
believed  to  arise  from  the  miasma  of  putrefaction. 
Medical  opinion,  however,  in  this  country,  is  still 
in  some  degree  undetermined  as  to  the  limits  of 

my  own  examination  of  two  of  these  writers,  viz.  Hippocrates 
and  Cclsus  ;  the  others  not  being  within  my  reach.  Celsus, 
who  may  be  said  to  treat  formally  of  the  Plague,  and  gives  a 
chapter  of  rules  for  escaping  it,  makes  no  mention  of  conta- 
gion ;  but  assigns  certain  winds,  that  is,  in  effect,  a  certain  de- 
gree of  heat  and  moisture,  as  the  cause  of  it. — See  Celsus  Dr 
Medecina,  p.  40,  41 . 


Proposal  of  a  nexv  Nomenclature  of  Fevers.     189 

Miasmatic  diseases.  Many  who  entertain  no 
doubts  with  respect  to  the  febrile  epidemics  of 
summer  and  autumn,  and  who  do  not  hesitate  to 
refer  the  pestilential  distempers  called  Plague  and 
Yellow  Fever  to  the  same  source,  are  still  unwil- 
ling to  consider  Typhus  as  coming  under  a  simi- 
lar denomination.  The  contagiousness  of  this 
latter  disease  is  yet  held  by  many  respectable  phy- 
sicians, who  long  since  denied  the  existence  of  that 
quality  in  Yellow  Fever  and  Plague.  It  is  one  of 
the  leading  objects  of  this  inquiry  to  ascertain  the 
relation  of  Typhus  to  Yellow  Fever  and  Plague, 
and  to  show  that,  with  some  peculiar  modifications 
in  the  manner  of  production,  it  is  truly  to  be  as- 
cribed to  a  similar  miasmatic  origin. 

In  order  to  maintain  this  opinion  concerning  the 
origin  of  Typhus,  and  to  exhibit  the  grounds  of 
the  new  nomenclature  of  Miasmatic  diseases  which 
is  here  to  be  proposed,  it  will  be  necessary  to  con- 
sider in  detail  the  modes  in  which  they  are  sup- 
posed to  be  severally  produced. 

The  miasma  which  excites  Yellow  Fever  and 
all  the  inferiour  grades  of  disease  termed  Remit- 
tents and  Intermittents,  is  emitted  from  dead  ani- 
mal and  vegetable  substances,  immersed  in  a  cer- 
tain degree  of  moisture,  and  undergoing  decom- 
position by  means  of  solar  heat.  Hence  these 
diseases  are  found  in  the  neighbourhood  of  low 


190    Proposal  of  a  new  Nomenclature  of  Fever*. 

and  swampy  grounds,  known  to  abound  in  this 
kind  of  filth,  and  at  that  season  when  such  filth  is 
powerfully  acted  upon  by  heat ;  or  they  are  found 
in  large  and  crowded  cities,  where  these  pernicious 
substances  are  collected  in  large  masses,  and  where 
the  heat,  from  a  variety  of  causes,  rises  much  high- 
er than  in  the  adjacent  country.  In  consequence 
of  the  quantity  of  these  putrefying  materials  which 
overspread  a  swampy  soil,  or  become  accumula- 
ted within  the  area  of  a  populous  town,  together 
with  the  high  heat  before  mentioned,  a  large  por- 
tion of  the  incumbent  air  is  rendered  noxious  by 
this  miasma,  and  a  frequent  result  is  epidemic 
disease.  While  the  warm  season  continues  to 
advance,  and  the  filth  remains  in  a  condition  to 
exhale  this  poison,  sickness  rages  with  increasing 
violence,  acquires  additional  virulence  and  a  more 
widely -spreading  malignity.  At  length  this  mi- 
asma banishes  or  overpowers  all  other  causes  of 
disease  within  the  range  of  its  activity,  usurps 
their  places,  and  thereby  forms  what  is  called  an 
epidemic  constitution.  This  view  of  the  subject 
is  confirmed  by  the  consequences  of  a  reduced 
temperature.  No  sooner  is  the  atmospheric  heat 
diminished  to  the  degree  which  is  called  cool 
weather,  and  especially  to  the  degree  of  frost,  than 
this  evil,  constantly  dependant  on  heat  for  its  ori- 
gin and  progress,  begins  to  subside,  and  speedily 
vanishes.  Solar  heat,  therefore,  operating  on 
masses  of  filth  exposed  to  the  open  air,  is  the 


Proposal  of  a  new  Nomenclature  of  Fevers.     191 

principal  agent  in  producing  the  miasma  of  Yel- 
low Fever. 


On  the  other  hand,  the  miasma  of  Typhus, 
while  it  bears  an  obvious  relation  to  that  just  de- 
scribed, exhibits  also  many  important  differences. 
Typhus  is  generally,  and,  it  is  believed,  always 
originally,  the  pestilence  of  poverty,  of  low  life,  of 
crowded  habitations,  of  personal  and  domestic 
filth.  In  the  evolution  of  the  miasma  of  Typhus, 
the  matter  of  perspiration,  and,  generally,  of  all  the 
excretions  of  the  human  body,  constitutes  the  ma- 
terial, and  animal  warmth  supplies  the  degree  of 
heat  necessary  to  prepare  and  set  loose  the  poison- 
ous gas.  No  large  masses  of  animal  and  vegeta- 
ble filth,  exposed  to  the  air  and  solar  heat,  are  re- 
quisite to  the  creation  of  the  typhous  miasma ;  for 
it  is  diffused  only  a  few  feet  from  its  source,  and 
the  general  atmosphere  of  cities  or  neighbourhoods 
is  never  contaminated  by  it ;  but,  in  order  to  find 
it,  we  must  examine  the  dress  and  persons,  or  the 
interior  economy  of  the  dwellings  of  the  miserable 
beings  by  whose  indigence,  negligence  and  filthi- 
ness  it  is  immediately  generated.  The  excesses 
of  solar  heat  are  not  wanted  to  ripen  this  destruc- 
tive evil ;  for  the  heat  of  the  human  body,  in  con- 
tact with  dress,  bedding,  furniture,  &c.  loaded 
with  animal  excretions,  and  rarely  changed,  wash- 
ed or  ventilated,  is  fully  sufficient  to  account  for 
the  formation  and  evolution  of  this  poison.    Hence 


192    Proposal  of  a  new  Nomenclature  of  Fevers. 

the  heat  of  summer,  so  far  from  being  necessary 
to  produce  the  miasma  of  Typhus,  is  altogether 
opposed  to  it,  by  inducing  that  freedom  in  the 
ventilation  of  houses,  clothes,  bedding  and  furni- 
ture, which,  by  diluting,  destroys  it  in  the  germ. 
Typhus,  therefore,  is  commonly  a  disease  of  cold 
climates  or  seasons,  where  the  habitations  of  the 
poor  and  filthy  are  crowded  and  shut  up,  and  where 
the  exhalations  from  human  excretions,  acted  upon 
by  animal  heat,  are  not  dissipated  nor  diluted  by 
the  admission  of  fresh  air. 

If  this  view  of  the  process  of  nature  in  the  con- 
stitution of  these  febrile  poisons  be  correct,  it  will 
not  be  deemed  improper  to  attempt  to  distinguish 
and  characterize  them  respectively  by  denomina- 
tions which  point  to  their  several  sources  and 
modes  of  production,  and  thereby  express  their 
relations  as  well  as  their  differences. 

Assuming,  therefore,  the  origin  and  modes  of 
production  of  the  two  species  of  miasmatic  poison 
which  have  been  just  described,  they  must  be 
considered  as  gaseous  fluids  floating  on  the  sur- 
faces, or  surrounding  the  bodies,  from  which  they 
are  respectively  exhaled ;  and  hence,  like  the  ethe- 
real fluids  of  magnetism  and  electricity,  they  may 
properly  be  called  miasmatic  atmospheres. 

In  order  to  distinguish  these  two  miasmatic  at- 


Proposal  of  a  new  Nomenclature  of  Fevers.    193 

mospheres,  and,  at  the  same  time,  duly  to  fix  in 
the  mind  the  impression  of  the  origin  and  produc- 
tion of  them,  it  is  judged  expedient  to  designate 
each  by  terms  which  will  invariably  express  the 
process  of  nature  in  their  formation.  As  the 
Greek  language  has  been  generally  resorted  to  in 
the  framing  of  scientific  nomenclature,  I  shall  em- 
ploy the  adjective  koinos,  common  or  public,  to 
denote  one  species  of  miasma,  and  iaios,  personal 
or  private,  to  denote  the  other.  The  application 
of  these  terms  will  be  readily  understood.  That 
portion  of  air  charged  with  miasmata  exhaled  by 
solar  heat  from  the  surface  of  swampy  grounds,  or 
from  masses  of  filth  overspreading  the  open  area 
of  cities,  according  to  this  distinction,  is  denomi- 
nated Atmosphcera  Koino-Miasmatica.  And  that 
other  small  portion  of  air,  contaminated  by  mias- 
mata emitted  from  and  surrounding  the  body, 
clothes,  bedding  and  furniture  of  persons  immer- 
sed in  the  filth  of  their  own  excretions,  and  of 
those  associated  in  the  same  family  with  them, 
accumulated,  long  retained,  and  acted  upon  by 
animal  heat,  is  denominated  Atmosphtera  Idio- 
Miasmatica  Or,  in  other  words,  the  Koino-mias- 
viatic  atmosphere  is  that  which  is  derived  from  a 
common  or  public  mass  of  putrefying  matter,  ex- 
panded to  the  solar  influence  ;  while,  on  the  con- 
trary, the  Idio -miasmatic  is  that  derived  from  a 
personal  or  private  source  ;  being  produced  from 
the  filth  of  individuals  and  their  habitations,  and 

2  B 


194    Proposal  of  a  new  Nomenclature  of  Fevers. 

diffused  around  them  only  for  a  small  distance. 
The  former  of  these  atmospheres  seems  to  be  ap- 
propriately termed  Koino-miasmatic ;  because  the 
pernicious  materials  which  create  it  lie  open  to 
public  view,  and  may  properly  be  called  public 
nuisances ;  are  collected  and  suffered  to  become 
virulent  by  public  remissness  and  negligence ; 
form  a  noxious  power  which  affects  the  whole  ad- 
jacent community,  and,  compared  with  typhous 
miasma,  is  of  considerable  extent ;  and  because 
they  properly  come  under  the  notice  of  the  ma- 
gistracy or  police,  as  being  a  source  of  public 
mischief.  The  latter  of  the  atmospheres  in  ques- 
tion is  properly  called  Idio -miasmatic ;  because 
the  pernicious  material  from  which  it  is  derived, 
is  made  up  of  excretions  from  the  bodies  of  indi- 
viduals ;  is  generally  the  result  of  personal  un- 
cleanliness  and  domestic  filth  ;  is,  when  compared 
with  the  former,  diffused  only  to  a  very  short  dis- 
tance from  its  source  ;  and  thus  adhering  to  the 
bodies  and  clothes  of  individuals,  or  to  the  bed- 
ding and  furniture  of  private  houses,  cannot  so 
readily  fall  under  the  notice  or  cognizance  of  the 
public  authority.* 

*  The  febrile  poison  which  is  so  frequently  generated  on 
board  of  ships,  and  thereby  gives  colour  to  the  opinion  of 
contagion  and  importation,  is  sometimes  Kohw-miasmatic, 
sometimes  Idio-Miasmatic.  Vessels  abounding  in  vegetable 
and  animal  filth,  and  navigating  the  warm  latitudes,  or  arriving 
in  port  during  a  hot  season,  will  be  apt  to  generate  the  former 


Proposal  of  a  fiew  Nomenclature  of  Fevers.    195 

The  reader  will  observe  that  the  denominations 
stated  above  have  a  principal  respect  to  the  source 
from  which  the  putrid  materials  are  derived, 
which,  when  acted  upon  by  heat,  emit  the  two 
kinds  of  miasmata.  It  occurred  to  me  that,  as 
solar  heat  chiefly  operates  in  the  one  case,  and  ani- 
mal heat  in  the  other,  the  denominations  might, 
perhaps,  with  equal  propriety,  be  drawn  from  the 
respective  sources  of  the  caloric  employed  in  the 
evolution  of  these  miasmata.  But  further  reflec- 
tion induced  me  to  adhere  to  the  first  impression. 
Solar  heat,  as  one  of  the  general  blessings  of  the 
world,  may  be  properly  said  to  be  common  or  pub- 
lic ;  and  animal  heat,  belonging  to  the  body  in 
which  it  is  evolved,  may  justly  be  considered  in  a 
personal  or  individual  sense.  The  terms  which 
have  been  selected  are  therefore  still  supposed  to 
be  sufficiently  appropriate,  whether  respect  be 
principally  had  to  the  quality  and  situation  of  the 
putrid  materials,  to  the  source  of  the  heat,  or  to 
the  extent  of  space  in  which  the  miasmata  may 
be  diffused. 

If  this  view  of  the  subject  be  correct,  it  will 
follow  that  the  two  kinds  of  febrile  poison  just  de- 
scribed will  produce  corresponding  kinds  of  fe- 

species  of  miasma ;  while,  such  as  sail  on  long  voyages,  and 
are  crowded  with  passengers,  who  neglect  or  are  deprived  of 
the  means  of  cleanliness  and  ventilation,  will  he  chiefly  liahfo 
to  produce  the  latter. 


196    Proposal  of  a  new  Nomenclature  of  Fevers. 

brile  disease,  one  of  which  may  be  distinguished 
by  the  title  of  *  Pyrexia  Koino-miasmatica,  the 
other  by  that  of  Pyrexia  Idio-miasmatwa.  Under 
the  former,  as  was  said  before,  will  be  included 
the  Oriental  Plague,  Yellow  Fever,  and  all  the  in- 
ferior grades  called  Remittents  and  Intermittents; 
while  under  the  latter  will  stand  all  the  varieties 
of  Typhus. 

It  would  be  a  subject  of  curious  and  interesting 
inquiry,  how  far  these  different  febrile  poisons  are 
susceptible  of  being  blended,  and  thereby  of  pro- 
ducing effects  of  a  mixed  kind  ;  and  likewise  how 
far  the  Idio-miasmatic  atmosphere,  by  means  of 
high  solar  heat  and  other  concurring  circumstan- 
ces, is  capable  of  conversion  into  the  Koino-mias- 
matic  atmosphere.  Instances  of  the  latter  occur- 
rence, it  is  believed,  might  be  adduced,  and  satis- 
factorily substantiated. 

If  the  account  here  given  of  the  origin  of  these 

*  The  word  Pyrexia  is  here  preferred  to  Febris,  or  Fever, 
first,  for  the  sake  of  preserving  uniformity  of  language  in  the 
choice  of  these  terms ;  and,  secondly,  because  Febris,  as  used 
by  the  nosologists,  does  not  seem  properly  adapted  to  the 
purpose.  Dr.  Cullen  gives  the  following  character  to  his  or- 
der of  Febres :  "  Praegressis  languore,  lassitudine,  et  aliis  de- 
bilitatis  signis,  pyrexia,  sine  morbo  locali  piimario."  The 
existence  of  Fever,  according  to  this  description,  without  a 
primary  local  affection,  appears  to  be  doubtful,  if  not  wholly 
improbable. 


Proposal  of  a  new  Nomenclature  of  Fevers.    197 

Miasmatic  diseases  should  be  found  conformable 
to  truth,  it  becomes  easy  to  explain  the  fact  of 
Koino- miasmatic  epidemics  being  only  observed 
in  warm  climates  or  seasons.  We  are  hence  also 
enabled  to  explain  the  reason  of  Typhus  being 
chiefly  a  disease  of  temperate  or  cold  climates,  of 
its  generally  prevailing  in  the  winter  and  other  cold 
seasons,  and  of  its  appearing  so  seldom  within  the 
tropics.  The  heat  of  the  human  body,  being  the 
same  in  all  ciimates  and  seasons  of  the  year,  must 
certainly  act  with  more  force  on  the  long- retained 
excretions  of  the  system,  adhering  to  the  skin, 
clothes,  bedding  and  furniture  of  the  indigent  and 
filthy,  shut  up  in  their  small,  low,  crowded,  un- 
cleanly and  unventilated  dwellings,  in  cold  cli- 
mates, or  during  the  cold  seasons  of  the  year. 

Many  physicians,  to  whose  opinions  much  re- 
spect is  due,  and  who  firmly  hold  the  doctrine 
here  stated  concerning  the  Koino- miasmatic  dis- 
eases, cannot  be  induced  to  give  up  the  notion  of 
the  contagiousness  of  Typhus.  As  the  decision 
of  this  question  affects  a  doctrine  of  great  impor- 
tance, it  appears  to  be  justly  entitled  to  attention. 
But,  before  entering  on  the  question  whether  Ty- 
phus be  a  miasmatic  or  contagious  disease,  it  will 
be  necessary  strictly  to  define  what  is  here  meant 
respectively  by  contagion  and  miasma.  By  con- 
tagion is  understood  a  noxious  matter,  produced 
by  organic  action  of  diseased  human  bodies,  emit- 


198    Proposal  of  a  new  Nomenclature  of  Fevers. 

ted  from  such  bodies  or  from  substances  which 
have  been  in  contact  with  them,  and  causing  a 
similar  disease  in  persons  to  whom  it  is  applied. 
Of  such  contagion  the  small-pox  presents  the 
most  unequivocal  example.  By  miasma  is  meant 
that  noxious  vapour  which  emanates  from  dead 
animal  and  vegetable  substances,  or  either  of 
them,  undergoing  decomposition,  and  which  is 
the  spontaneous  result  of  attractions  and  repulsions 
conferred  by  nature  on  the  elementary  particles  of 
which  it  is  composed.  Contagion,  therefore,  is  a 
poison  of  animal  production,  and  miasma  a  poison 
of  chemical  production. 

That  the  remote  cause  of  Typhus  is  a  miasma 
or  chemical  poison,  and  not  a  contagion,  seems  to 
be  proved  by  its  not  depending  on  the  disease  it- 
self for  its  origin,  but  being  occasionally  generated 
wherever  the  requisite  circumstances  happen  to 
coincide.  Dr.  Cullen  observes  ( First  Lines,  vol.  i, 
p.  70,)  "  that  the  effluvia  constantly  arising  from 
the  living  human  body,  if  long  retained  in  the 
same  place,  without  being  diffused  in  the  atmos- 
phere, acquire  a  singular  virulence."  And  again 
(p.  71 :)  "It  is  probable  that  the  contagion  arising 
in  this  manner  is  not,  like  many  other  contagions, 
permanent  and  constantly  existing ;  but  that,  in 
the  circumstances  mentioned,  it  is  occasionally  ge- 
nerated." Other  authorities,  if  necessary,  might 
be  brought  ill  support  of  this  opinion. 


Proposal  of  a  new  Nomenclature  of  Fevers.     199 

This  admission  is  greatly  unfavourable,  if  not 
fatal,  to  the  doctrine  of  the  contagiousness  of  Ty- 
phus. The  occasional  generation  of  the  disease 
de  novo  is  proof  of  its  arising  without  contagion ; 
for  contagion  being  a  morbid  secretion,  cannot 
exist  previously  to  the  disease  which  engenders  it; 
and  if  miasma,  thus  occasionally  generated,  can 
produce  Typhus,  why  may  not  the  same  agent,  by 
a  continued  and  progressive  generation ,  wherever 
the  materials  requisite  to  its  formation  exist,  go 
on  indefinitely  to  propagate  the  disease  ?  To 
deny  this,  and  to  insist  on  the  successive  propa- 
gation of  Typhus  by  means  of  contagion,  unless 
clear  proof  be  alleged,  is  unphilosophical ;  as  it 
supposes  the  operation  of  two  causes,  when  one 
only  is  proved  to  exist,  and  when  that  one  is  suf- 
ficient to  account  for  all  the  phenomena.  Many 
clear  cases  of  the  operation  of  miasmata  in  produ- 
cing Typhus,  and  of  the  absence  of  contagion  in 
the  same  cases,  might,  if  necessary,  be  adduced. 
The  memorable  Black  Assizes  at  Oxford,  in  1571 , 
furnish  an  instance  of  this.  Many  of  the  court  and 
jury  were  infected  by  miasmata,  exhaled  from  the 
filthy  clothes  and  persons  of  the  prisoners  just 
brought  out  from  their  dungeons,  though  these 
prisoners  were  not  sick  themselves  ;  and  no  other 
persons  were  afterwards  infected  by  the  sick, 
though  the  disease  was  extremely  malignant  and 
fatal.      A  similar  occurrence  took  place  at  the 


200    Proposal  of  a  new  Nomenclature  of  Fevers. 

sessions  of  the  Old  Bailey  in  1750.*  And  Dr. 
Haygarth  of  Bath,  in  England,  one  of  the  most 
credulous  contagionists  of  the  present  time,  admits 
that  a  typhous  patient,  removed  from  the  filthy 
dwelling  where  the  illness  was  contracted,  strip- 
ped of  infectious  clothing,  thoroughly  washed  and 
cleansed,  and  then  lodged  in  a  spacious  and  ven- 
tilated chamber,  seldom  or  never  communicates 
contagion  to  the  attendants,  f  This  is,  in  effect, 
to  say  that,  when  all  existing  miasmata  are  dispel- 
led, and  the  means  of  generating  more  are  pre- 
cluded, the  danger  of  infection  no  longer  exists. 
But  what  effect  would  washing  and  ventilating  be 
expected  to  produce,  during  the  course  of  the 
Small-pox,  towards  annihilating  the  contagion? 

The  practical  writers  inform  us  that  the  con- 
tagion of  Typhus,  as  it  arises  from  fomites,  is 
more  powerful  than  as  it  arises  immediately  from 
the  human  body.  This  fact  is  easily  explained 
on  the  supposition  of  the  morbid  principle,  in  this 
instance,  being  a  miasma  chemically  constituted ; 
for  the  more  perfect  the  combination  of  the  ele- 
mentary particles  composing  a  chemical  poison, 
the  more  perfect,  that  is,  the  more  virulent,  will 

*  See  Blane'?  Observations  on  the  Diseases  of  Seamen, 
p.  216. 

f  Letter  to  Dr.  Percival  on  the  Prevention  of  Infectious? 

Fever?. 


Proposal  of  a  new  Nomenclature  of  Fevers.    201 

the  poison  be  rendered.  But  on  the  supposition 
of  the  morbid  principle  of  Typhus  being  an  ani- 
mal poison,  secreted  by  vascular  action,  the  aug- 
mented virulence  of  fomites,  as  stated  with  respect 
to  this  disease,  is  altogether  inexplicable.  Animal 
poisons  are  universally  in  the  most  active  state  as 
they  immediately  issue  from  the  bodies  which 
produce  them.  The  virus  of  the  Small- Pox  is  the 
most  active  in  the  moment  of  taking  it  in  its  re- 
cent and  fluid  state  ;  the  virus  of  the  Vaccine 
disease  is  the  same,  as  is  likewise  that  of  a  rabid 
animal,  of  the  viper,  &c.  Every  day  that  these 
poisons  are  kept,  they  become  progressively  weak- 
er and  weaker,  till  at  length  their  activity  is  en- 
tirely extinguished.  An  example  of  any  one  of 
them  becoming  more  virulent  by  keeping  cannot 
be  produced.  There  is  every  reason  to  believe 
that  a  chemical  action  taking  place  in  an  animal 
poison,  after  its  separation  from  the  body,  (and 
this  is  the  kind  of  action  which  must  take  place) 
has  a  speedy  effect  to  destroy  instead  of  increasing 
the  virulence.  The  effects  of  fermentation  on  va- 
riolous pus  seem  to  establish  this  conclusion. 
The  result  of  chemical  action  on  vegetable  poisons 
appeals  to  be  the  same  ;  and  there  is  probably  no 
exception  among  all  the  virulent  matters  which  are 
the  product  of  organic  nature. 

In  deciding  on  the  contagiousness  of  diseases, 
it  is  essential  to  ascertain  whether  the  morbid 

2  c 


202    Proposal  of  a  new  Nomenclature  of  Fevers. 

principle  be  a  matter  of  animal  or  chemical  pro- 
duction. The  miasmatic  poisons  are  unquestion- 
ably of  chemical  origin,  formed  without  any  fe- 
brile, morbid,  or  organic  action  of  any  kind  ;  and 
therefore  they  cannot  be  confounded  with  conta- 
gions without  a  gross  abuse  of  terms  ;  and,  on 
the  other  hand,  the  animal  poisons,  or  such  as  are 
secreted  by  the  vascular  energy  of  the  animal 
body,  can  alone,  with  propriety,  be  denominated 
contagions. 

By  considering  Typhus  as  a  branch  of  the  Mi- 
asmatic diseases,  we  produce  a  simplicity,  unifor- 
mity, and  elegant  arrondissement  in  the  doctrine 
of  fevers,  which  cannot  but  recommend  it  to  all 
who  admire  the  regularity  of  nature.  The  error 
of  blending  contagiousness  with  miasmatic  poison, 
withdraws  men's  attention  from  the  noxiousness 
of  personal  and  domestic  filth  as  well  as  public 
nuisances.  This  is  an  object  to  which  the  care 
of  the  community  cannot  be  too  frequently  or  too 
loudly  called.  If  cleanliness  be  conducive  to 
decency,  comfort,  elegance,  morality,  intellectual 
activity,  and  the  dignity  of  human  nature,  it  is 
likewise  eminently  so  to  safety,  health  and  long 
life. 


AN 

INTRODUCTORY  LECTURE, 


ON  THE  INFLUENCE 


OF  TEMPERATURE 


ON 


HEALTH 


AND 


NATIONAL  CHARACTER. 


TO 


ALEXANDER    H.    STEVENS* 
M.  D. 

NEW-YORK. 


My  Dear  Sir, 

IF  I  mistake  not,  one,  at  least,  of  the  following 
Lectures  was  delivered  while  You  were  studying 
Medicine  under  the  direction  of  the  Author,  and 
probably  in  your  hearing. 

But  this  is  by  no  means  the  only  inducement  to 
connect  your  name  with  the  publication.  The 
respectful  and  reciprocal  partiality  which  was 
known  to  subsist  between  my  Brother  and  You, 
while  you  bore  to  each  other  the  relation  of  Pre- 
ceptor and  Pupil ;  the  fond  expectation  with 
which  he  followed  you,  while  subsequently  pur- 
suing your  studies  in  the  Schools  of  Europe  ;  the 
strain  of  your  letters  to  him  during  your  absence; 
and,  allow  me  to  add,  the  unfeigned  pleasure  with 
which,  had  it  pleased  Providence  to  spare  his  life, 
He  would,  undoubtedly,  have  witnessed  your  re- 
turn, with  flattering  prospects,  to  your  native 
Country  ;  are  all  considerations  which  render  this 
public  testimony  of  regard  peculiarly  proper,  and 
which  afford  me  peculiar  gratification  in  offering  it. 


[     206     ] 

That  your  career  may  be  more  and  more 
honourable  to  Yourself,  and  useful  to  mankind ; 
and  that  when  the  "  last  enemy,"  who  deprived  us 
of  your  Preceptor,  shall  be  commissioned  to  ter- 
minate Your  earthly  course,  he  may  find  you,  by 
the  grace  of  God,  prepared  for  "a  better  country 
that  is  an  heavenly,"  is  the  unfeigned  wish  and 
prayer  of, 

My  dear  Sir, 

Your  sincere  friend, 

THE  EDITOR. 


Princeton,  N.  J. 
Jan.  28th,  1814 


:} 


ADVERTISEMENT. 

THE  following  Lectures  were  neither  prepared  nor  in- 
tended, by  the  Author,  for  the  press.  He  was  in  the  habit  of 
putting  his  ideas,  on  distinct  scraps  of  paper,  during  the  short 
intervals  of  leisure  which  his  extensive  practice  allowed  him 
to  enjoy.  These  several  manuscripts  usually  terminated  at 
the  end  of  paragraphs  ;  and  although,  in  that  state,  the  Author 
himself  was  able  to  use  them  widiout  difficulty ;  yet  not  hav- 
ing been  paged,  or  left  in  due  order  at  his  decease,  it  is  to  be 
feared  that,  in  some  parts,  the  arrangement,  after  all  the  at- 
tention and  care  that  could  be  bestowed,  may  not  be  that  in 
which  the  Lectures  were  delivered.  This  statement,  it  is 
hoped,  will  disarm  the  severity  of  criticism.  The  Editor  does 
not,  by  any  means,  present  the  following  discourses  to  the 
reader,  as  finished  compositions;  but  merely  as  hasty  sketches, 
worthy  of  being  rescued  from  oblivion. 


INTRODUCTORY    LECTURE, 
&c.   &c. 


J.  HE  principles  of  the  science,  which  the  Med- 
ical Profession  is  destined  to  cultivate  and  to  prac- 
tise, are  inseparably  interwoven  with  every  stage 
and  condition  of  life.  The  existence  of  mankind, 
in  their  present  state,  and  the  origin  as  well  as  the 
necessity,  of  some  knowledge  on  this  subject,  were 
nearly  coeval.  There  is  nothing  in  the  history  of 
human  nature  which  more  forcibly  demands  at- 
tention, or  more  imperiously  urges  us  to  inquiry 
and  exertion,  than  our  universal  liableness  to  sick- 
ness, pain  and  dissolution.  At  the  earliest  dawn 
of  life,  diseases  begin  to  assail  us — they  harass  the 
periods  of  infancy  and  childhood  by  innumerable 
sufferings  and  dangers,  and  too  often  blast  their 
fairest  hopes  by  an  untimely  frost — they  are  not 
much  less  hostile  to  the  vigour  and  ripeness  of 
manhood — and  they  incessantly  increase  the  bur- 
dens and  imbitter  the  infirmities  of  declining  age. 

2  D 


210  Introductory  Lecture. 

A  constitution  the  most  hardy,  and  which  seems 
to  bid  defiance  to  all  the  enemies  of  health  that 
surround  it,  is  by  no  means  proof  against  the 
slow,  insidious,  undermining  attacks  of  age.  E- 
ven  "  in  the  midst  of  life  we  are  in  death."  Sad 
experience  frequently  brings  all  the  realities  of  this 
gloomy  picture  before  our  eyes.  On  one  day  we 
behold  the  vigorous  and  graceful  form,  flushed 
with  the  glow  of  health  and  exulting  in  all  the 
powers  of  activity  ;  the  eye  sparkling  with  intel- 
ligence ;  the  countenance  enlivened  by  wit,  ani- 
mated by  feeling,  and  beaming  with  cheerfulness 
and  benevolence.  A  single  instant  is  sufficient  to 
dispel  the  charm.  Often  without  apparent  cause, 
sensation  and  motion  cease  at  once  ;  the  body 
loses  its  warmth,  the  eyes  their  lustre ;  the  lips 
and  cheeks  become  livid.  But  these,  as  an  emi- 
nent naturalist*  observes,  are  only  the  preludes  to 
changes  still  more  hideous.  The  colour  passes 
successively  to  a  blue,  a  green  and  a  black  ;  the 
flesh  absorbs  moisture,  and  while  one  part  of  it 
escapes  in  pestilential  exhalations,  the  remaining 
part  falls  down  into  a  putrid  liquid  mass.  In  a 
short  time  no  part  of  the  body  remains,  but  a  few 
earthy  and  saline  principles ;  its  other  elements 
being  dispersed  through  the  air,  or  carried  off  by 
water,  to  form  new  combinations,  and  afford  food 
for  other  animals. — Such  is  the  fate  of  man,  as  he 

*  Bichat. 


Introductory  Lecture,  211 

is  presented  to  the  eyes  of  the  medical  observer ! 
Whatever  prerogatives  or  distinctions,  with  re- 
gard to  other  things,  may  be  claimed  by  persons 
who  enjoy  the  higher  stations  in  society,  they  form 
no  barrier  against  the  assault  of  diseases  ;  neither 
the  pride  of  birth,  the  splendour  of  opulence,  nor 
the  magnificence  of  royal  or  imperial  dignity,  can 
grant  a  moment's  respite  to  that  sentence  of  disso- 
lution which  Nature  has  irrevocably  pronounced. 

These  evils  are  so  deeply  inherent  in  human 
nature,  that  they  form  an  essential  part  in  the  ope- 
rations of  the  frame  and  constitution  of  man.  To 
waste,  to  sicken  and  to  die,  are  as  natural  as  to 
live,  to  be  nourished,  and  to  improve  in  vigour 
and  activity.  In  all  ages  of  the  world,  in  every 
region  of  the  globe,  in  the  various  states  of  society, 
and  in  the  diversified  conditions  of  mankind,  we 
observe,  with  only  few  and  trivial  differences,  a 
perpetual  reiteration  of  the  same  noxious  influ- 
ences, which  more  suddenly  or  more  gradually 
destroy  our  health,  and  eventually  terminate  our 
lives.  In  innumerable  different  forms  of  approach, 
and  in  a  thousand  sad  varieties  of  woe,  this  group 
of  ills  obtrude  themselves  on  our  view.  In  a 
word,  they  lend  to  history  some  of  its  most  stri- 
king features — to  portray  many  of  its  most  pa- 
thetic images — and  in  the  heart  of  sympathy  they 
produce  a  large  proportion  of  its  most  impassioned 
and  interesting  emotions. 


212  Introductory  Lecture. 

Notwithstanding  this  universality  of  diseases, 
their  concomitant  consequences,  a  very  slight 
survey  of  the  world,  and  a  moment's  appeal  to 
experience  and  observation  will  be  sufficient  to 
convince  us  that  they  exhibit  much  diversity,  as 
to  their  appearance,  prevalence  and  effects,  in  dif- 
ferent countries.  A  description  of  this  diversity 
at  full  length  would  exhibit  a  kind  of  medical  Geo- 
graphy ;  but  the  task  would  exceed  the  limits  pre- 
scribed to  a  discourse  of  this  kind,  which  from  its 
nature,  must  be  restricted  to  general  views  and 
cursory  notices  of  whatever  subject  happens  to  be 
selected.  Instead  of  attempting,  therefore,  to  go 
far  into  the  inquiry,  I  shall  only  presume  to  offer 
a  brief  and  rapid  sketch  of  a  few  of  the  more  im- 
portant sources  of  disease  in  our  own  country, 
and  occasionally  to  compare  them  with  those  of 
other  parts  of  the  world. 

Among  the  noxious  powers  which  claim  our 
notice  in  the  first  place,  are  Heat  and  Cold,  or,  to 
speak  more  properly  high  and  low  temperature. 
Though  these  are  obviously  relative  terms,  and 
constantly  to  be  understood  in  that  sense  ;  it  is 
well  known,  that  not  only  the  extreme  degrees  of 
both  are  productive  of  much  injury  to  the  human 
constitution,  but  that  changes  or  vicissitudes,  even 
of  the  more  moderate  degrees,  especially  when 
they  occur  suddenly,  are  scarcely  less  pernicious. 


Introductory  Lecture.  213 

The  effects  of  excessive  Heaty  in  its  direct  opera- 
tion, are  doubtless  very  unfriendly  to  the  human 
body  in  a  variety  of  ways  ;  but  it  is  to  its  indirect 
or  consequential  agency,  as  will  hereafter  appear, 
that  we  are  to  ascribe  some  of  its  most  noxious 
impressions.  In  passing  to  the  opposite  extreme, 
it  may  be  safely  pronounced,  that  there  is  no  evil 
incident  to  animal  nature  which  occasions  such  an 
extent  of  annoyance  and  distress,  as  what  is  po- 
pularly called  Cold.  In  this  view  of  the  subject, 
Cold  is  considered  not  only  a  source  of  disease,  but 
as  the  privation  of  a  comfort  essential  to  our  well- 
being,  the  absence  of  which,  often  inflicts  the 
severest  misery. 

It  would  be  easy,  by  descending  to  a  few  par- 
ticulars, to  demonstrate  the  operation  of  this  agent 
in  producing  a  long  catalogue  of  acute  and  chronic 
diseases.     The  memorable  conclusion  of  Syden- 
ham, which  is  so  often  repeated  for  the  purpose  of 
inculcating  the  seriousness,  and  magnitude  of  this 
evil — that  cold  destroys  a  much  greater  number  of 
mankind  than  the  combined  ravages  of  war,  fa- 
mine and  pestilence , — is  unhappily  verified  by  uni- 
versal experience.     By  recurring  to  the  relative 
import  of  the  term,  and  by  connecting  diminution 
with  variation  of  temperature,   it  plainly  results 
that  cold  may   operate   injuriously  in  all  parts  of 
the  globe  :  and  by   still  further  taking  into  view 
the  additional  force  which  it  often  gives  to  other 


214  Introductory  Lecture. 

morbid   causes,    we   perceive   another  immense 
range  of  its  destructive  influence. 

It  must  be  familiarly  known  to  this  enlightened 
audience  that  the  moral  and  political,  as  well  as 
the  medical  consideration  of  temperature,  has  at- 
tracted much  attention.  And  I  trust  it  will  not 
be  deemed  too  wide  a  departure  from  the  objects 
of  this  discourse,  to  notice  some  of  the  more  prom- 
inent opinions  which  have  been  held  on  this  point. 
The  connection  between  those  several  modes  of 
its  operation  is,  indeed,  so  intimate,  that  they 
are  calculated  reciprocally  to  throw  light  on  one 
another. 

The  effects  resulting  from  high,  low,  and  mode- 
rate temperature,  as  experienced  by  man  in  dif- 
ferent parts  of  the  world,  are  so  obscured  and  mo- 
dified by  other  circumstances,  that  the  comparison 
of  their  advantages  and  disadvantages  in  a  general 
estimate,  becomes  extremely  complicated.  It  has 
been  commonly  held,  that  in  every  region  of  the 
earth,  the  power  of  temperature  operates,  with  de- 
cisive influence,  upon  the  character  and  condition, 
as  well  as  the  diseases,  of  human  beings  ;  and  that 
in  those  countries  which  approach  near  to  the  ex- 
tremes of  heat  and  cold,  this  influence  is  so  con- 
spicuous as  to  strike  every  beholder.  In  conse- 
quence of  this  impression,  the  middle  latitudes 
have  been  generally  supposed  to  enjoy  the  bless- 


Introductory  Lecture.  215 

ings  of  nature  in  an  unrivalled  degree.  "  Whether 
we  consider  man,"  says  an  admired  historian, 
"  merely  as  an  animal,  or  as  a  being  endowed 
"  with  rational  powers,  which  fit  him  for  activity 
"  and  speculation,  we  shall  find  that  he  has  uni- 
"  formly  attained  the  greatest  perfection  of  which 
"  his  nature  is  capable,  in  the  temperate  regions 
"  of  the  globe.  There  his  constitution  is  most 
"  vigorous,  his  organs  most  acute,  and  his  form 
V  most  beautiful.  There,  too,  he  possesses  a 
"  superior  extent  of  capacity,  greater  fertility  of 
"  imagination,  more  enterprising  courage,  and  a 
"  sensibility  of  heart  which  gives  birth  to  pas- 
"  sions,  not  only  ardent,  but  persevering.  In  this 
"  favourite  situation  he  has  displayed  the  utmost 
"  efforts  of  his  genius,  in  literature,  in  policy,  in 
"  commerce,  in  war,  and  in  all  the  arts  which 
"  improve  or  embellish  life." 

It  is  chiefly  with  respect  to  temperature,  that  so 
much  stress  has  been  laid  on  the  effects  of  those 
imaginary  bands  or  zones,  encircling  the  earth,  and 
denominated  Climates.  These  divisions  of  the 
globe,  terminated  by  lines  parallel  to  the  equator, 
have  been  invented  by  geographers  to  designate 
that  difference  in  the  length  of  days  and  nights, 
degrees  of  temperature,  and  some  other  effects, 
which  result  from  the  inclination  or  obliquity  of 
the  sphere.  In  popular  acceptation,  however,  the 
term   climate   is   generally   bestowed  upon   any 


216  Introductory  Lecture. 

country  or  region  differing  from  another,  either  in 
respect  of  the  seasons,  the  quality  and  productions 
of  the  soil,  or  even  in  some  instances  the  customs 
and  manners  of  the  inhabitants,  ay  ithout  any  pre- 
cise regard  to  the  circumstances  on  which  the  dis- 
tinction was  originally  founded. 

If  we  admit  the  moral  and  political  influence  of 
temperature  and  climate,  to  the  degree  contended 
for  by  many,  we  shall  be  the  more  disposed  to 
yield  our  assent  to  the  opinion  of  its  power  over 
the  health  and  bodily  constitution  of  individuals. 
Montesquieu,  in  his  "  Spirit  of  Laws ,"  seems  to 
have  proceeded  further  than  any  other  in  maintain- 
ing this  doctrine.  He  ascribes  to  the  force  of 
climate,  the  principal  differences  which  have  been 
found  in  the  manners,  characters,  government, 
laws  and  religion  of  different  nations.  In  cold 
countries,  he  observes,  people  are  more  vigorous; 
and  this  superiority  of  strength  produces  many 
striking  effects,  such  as  intrepidity  and  conscious 
elevation,  which  banish  revenge  and  cruelty ;  it 
likewise  produces  an  higher  sense  of  independence 
and  security,  and,  while  it  cherishes  frankness  and 
confidence,  it  repels  suspicion,  artifice  and  cun- 
ning.— On  the  other  hand,  he  contends,  that  the 
inhabitants  of  warm  countries  are  more  feeble  and 
timorous,  and  possess  more  exquisite  sensibility  ; 
and  he  believes  indeed  that  the  heat  of  climate 
may  be  so  excessive  as  to  deprive  the  body  of  all 


Introductory  Lecture.  217 

vigour  and  activity.  From  the  body,  this  feeble- 
ness is  communicated  to  the  mind  ;  active  curi- 
osity, daring  enterprise,  generous  sentiments,  are 
all  extinguished  ;  the  inclinations  become  debased 
and  passive  ;  indolence  constitutes  the  highest 
happiness  ;  no  punishment  is  so  severe  as  the  ex- 
ercise of  the  understanding  ;  and  slavery,  with  all 
its  humiliation,  is  more  supportable  than  the  vi- 
gour and  exertion  of  mind  necessary  for  the  main- 
tenance of  freedom  and  independence.  The  facts 
respecting  the  indolence  of  the  Indians,  and  the 
effeminacy  of  the  Asiatics,  are  supposed  fully  to 
establish  this  principle.  In  his  career  of  generali- 
zation, Montesquieu  ascribes  these  effects  to  the  in- 
fluence of  heat,  and  lays  it  down  as  an  axiom,  that 
the  inhabitants  of  hot  countries  must  necessarily  be 
indolent,  inert  in  body,  and,  of  consequence,  inert 
in  mind  and  character.  He  even  proceeds  a  step 
further,  and  maintains  that  unlimited  monarchy 
grows  out  of  the  condition  of  these  nations  ;  and 
considering  despotism  as  the  effect  of  that  supine- 
ness  generated  by  heat,  he  concludes  that  despo- 
tism is  the  natural  government  of  such  countries, 
and  as  unavoidable  as  any  of  the  other  conse- 
quences of  the  climate  under  which  they  live. 

Notwithstanding  the  speciousness  of  this  doc- 
trine, the  eloquence  with  which  it  has   been  en- 
forced, and  the  eager  reception  it  has  obtained 
among  intelligent  men,  it  seems  to  be  liable  to  in- 
2  E 


218  Introductory  Lecture. 

surmountable  objections,  and  has  been  often  op- 
posed by  great  force  of  facts  and  argument. 

The  records  of  history,  it  has  been  said,  appear 
to  give  little  countenance  to  this  doctrine.  The 
ambition  and  conquests  of  the  Assyrians,  for  more 
than  500  years,  agitated  a  great  part  of  the  Asiatic 
world.  This  vast  empire  was  in  its  turn  over- 
thrown by  the  Medes.  The  Persians,  under  Cy- 
rus, within  the  space  of  30  years,  extended  their 
conquests  and  ravages  from  the  Indus  to  the  Me- 
diterranean. Achievements  such  as  these,  surely 
give  no  proof  of  bodily  or  mental  enervation.  But 
if  the  proofs  of  energy  derived  from  war  and 
conquest,  should  not  be  deemed  sufficient  to 
efface  our  impressions  of  the  enervating  influ- 
ence of  heat,  let  us  behold  the  evidences  of  vigour 
in  other  departments  of  exertion  and  enterprise. 
The  Phoenicians,  for  many  centuries,  were  in  pos- 
session of  the  commerce  of  the  whole  ancient 
world.  The  ruins  of  Palmyra  are  stupendous 
monuments  of  the  industry,  magnificence  and 
taste  of  that  celebrated  city.  If  these  are  marks 
of  indolence,  where  shall  we  look  for  activity  and 
vigour  ? 

But,  if  the  influence  of  climate  be  so  predomi- 
nant and  irresistible,  why  in  the  same  countries 
where  so  much  energy  was  formerly  displayed,  do 
we  now  find  such  degrading  indolence,  such  uni- 


Introductory  Lecture.  219 

versal  degeneracy  ?  Why  are  the  modern  Greeks 
so  much  debased  amidst  the  very  ruins  of  Sparta 
and  Athens,  and  in  the  fields  of  Marathon  and 
Thermopylae  ?  If  indolence  be  peculiar  to  south- 
ern countries,  how  shall  we  account  for  a  Carthage 
in  Africa,  a  Rome  in  Italy,  and  the  Buccaneers  in 
the  West- Indies. — These  are  some  of  the  facts 
and  reasonings  by  which  the  doctrine  of  Montes- 
quieu has  been  often  assailed  and  refuted.  They 
seem  to  be  entirely  unanswerable.  For,  however 
disposed  we  may  be  to  admit  the  power  of  heat 
over  the  bodies  and  minds  of  men,  it  must  be  al- 
lowed that  moral  and  political  causes  affect  the 
character  of  nations,  as  well  as  individuals,  still 
more  decisively  than  the  influence  of  climate. 

But,  to  return  from  this  digression  to  the  con- 
sideration of  temperature,  as  it  exists  in  our  own 
country.  The  United  States,  stretching  from  the 
31st  to  the  47th  deg.  of  N.  latitude,  comprise,  of 
course,  a  great  variety  of  climate,  and  open  a  large 
field  for  the  observation  of  the  effects  of  heat  and 
cold  upon  the  temper  and  character,  as  well  as 
the  constitutions  and  diseases  of  the  inhabitants. 
Although  we  may  justly  claim  an  exemption, 
throughout  the  whole  of  our  territory,  from  those 
strong  lines  of  impression,  which  so  decisively 
characterize  men,  and  distinguish  diseases,  in  the 
higher  and  lower  latitudes,  it  must  be  admitted 
that  the  differences  are  by  no  means  faint  or  diffi- 


220  Introductory  Lecture. 

cult  to  be  perceived.  To  give  a  satisfactory  ex  - 
planation  of  all  these  differences,  would  not  be  an 
easy  task.  After  allowing  something,  and  even 
much,  for  the  diversity  of  temperature,  we  are 
compelled  to  allow  still  more  for  the  differences  of 
the  condition  of  the  people,  in  the  opposite  ex- 
tremes of  the  Union.  It  may  be  asserted  that  all 
action,  whether  of  body  or  mind,  has  its  chief 
source  in  our  necessities,  and  progressively  aug- 
ments as  they  increase.  The  facility  of  obtaining 
a  great  quantity  of  food  depends  much  on  the 
soil.  Hence  it  results  that  the  nature  of  the  soil 
has  a  real  influence  on  activity  ;  and  we  must  per- 
ceive, that,  in  the  social  as  well  as  in  the  savage 
state,  a  country,  in  which  the  means  of  subsistence 
are  somewhat  difficult  to  be  procured,  will  al- 
ways have  active  and  industrious  inhabitants; 
while  in  another,  where  nature  has  lavished  every 
thing  with  an  unsparing  hand,  the  people  will  be 
indolent  and  inactive.  It  is  not,  therefore,  as  in- 
habitants of  hot,  but  as  inhabitants  of  rich  coun- 
tries, that  nations  are  inclined  to  indolence. 

In  applying  these  remarks  to  the  northern  and 
southern  States  of  the  Union,  it  would  seem  pro- 
bable, even  if  observation  did  not  attest  the  fact, 
that  the  ruggedness  and  sterility  of  soil  in  the 
north,  aided  by  the  degree  and  duration  of  cold, 
must  produce  a  hardy,  active  and  industrious  race 
of  inhabitants  ;  while  the  exuberant  fertility  and 


Introductory  Lecture.  221 

rich  productions  of  the  south,  with  the  addition- 
al advantages  of  a  milder  climate,  must  cherish 
the  propensity  to  indolence  and  effeminacy. 

A  comparative  view  of  the  diseases  most  pre- 
valent in  the  northern  and  southern  States,  renders 
it  difficult  to  decide  which  portion  of  the  Union 
ought  to  be  regarded  as  the  more  healthy.  Pul- 
monary consumption  in  the  north  may  be  con- 
sidered nearly  as  an  equivalent  to  the  malignant 
diseases  of  the  summer  and  autumn  in  the  south. 
The  former  more  properly  belongs  to  the  class  of 
disorders  originating  from  variation  of  tempera- 
ture ;  while  the  latter  fall  under  that  head  of  nox- 
ious powers  which  will  be  treated  of  in  the  next 
place. 

In  the  whole  catalogue  of  maladies  incident  to 
mankind,  there  is  none  which  presents  to  the  com- 
munity so  gloomy  a  prospect  as  pulmonary  con- 
sumption. In  proportion  as  society  becomes 
luxurious,  refined  and  artificial,  in  proportion 
as  all  traces  of  the  robust  constitutions  of  our  an- 
cestors become  obliterated  in  the  systems  of  their 
descendants,  the  inequalities  and  vicissitudes  of 
temperature,  which  are  so  incessantly  taking  place 
in  this  climate,  will  daily  become  more  and  more 
productive  of  this  evil.  Of  other  complaints  we 
may  expect  some  alleviation  from  the  progressive 
improvements  in  the  state  of  our  soil,  and  in  the 


222  Introductory  Lecture. 

police  of  our  cities,  or  from  a  more  benignant  con- 
stitution of  air ;  but  consumption,  like  an  ever- 
active  and  ever- wasting  pestilence,  knows  no  in- 
termission, suffers  no  abatement,  and  probably 
derives  additional  destructive  powers  from  some 
of  the  very  means,  which  are  successfully  employ- 
ed to  lessen  the  frequency  and  fatality  of  many 
other  diseases.  Whether  medicine,  in  its  most 
improved  state,  may  ever  be  able  to  devise  a  plan 
to  arrest  the  career  of  this  gigantic  destroyer,  may 
perhaps  remain  a  subject  of  hope,  but,  there  is  too 
much  reason  to  fear,  not  of  trust  or  confidence. 

The  next  noxious  power  which  demands  atten- 
tion, is  that  commonly  known  to  physicians  under 
the  title  of  Miasmata,  a  corrupt  and  poisonous  ex- 
halation, the  offspring  of  putrefaction,  imparted  to 
the  air  we  breathe,  thereby  finding  admission  into 
the  body,  and  opportunity  to  diffuse  its  perni- 
cious influence. 

Miasmata,  as  a  generic  term,  may  be  divided 
into  two  species,  which  require  to  be  accurately 
distinguished,  even  for  the  purpose  of  that  general 
notice  of  the  subject  which  is  now  intended  to  be 
given. 

The  first  species  is  that  exhaled  from  a  low  and 
moist  soil,  abounding  in  decaying  animal  and  ve- 
getable matter,  acted  upon  by  solar  heat.     This 


Introductory  Lecture.  223 

may  be  diffused  to  some  distance  from  its  source, 
and  in  that  manner  may  spread  its  noxious  influ- 
ence over  cities,  neighbourhoods,  or  even  whole 
districts  of  country,  according  to  the  extent  of  the 
surface  from  which  it  is  exhaled. 

The  second  species,  much  more  limited  in 
origin  and  extent,  surrounds  and  envelopes  the 
bodies  of  men,  adheres  to  their  apparel,  bedding, 
furniture,  and  sometimes  even  to  the  walls,  floor, 
and  ceiling  of  their  habitations.  This  species  of 
miasmata  is  chiefly  found  in  the  abodes  of  poverty, 
wretchedness  and  filth,  where  human  beings  are 
crowded  together  in  a  small  space,  and  deprived 
of  the  ordinary  comforts  of  ventilation  and  clean- 
liness. 

The  first  mentioned  species  of  miasmata,  ex- 
haled from  a  noxious  soil,  may  be  considered  as 
holding  the  second  rank  in  the  catalogue  of  mor- 
bid causes ;  for  next  to  the  evils  arising  from  va- 
riation of  temperature,  it  is  undoubtedly  the  most 
universal  source  of  disease  in  nature.  However 
diversified  in  quantity,  concentration  or  virulence 
by  local  circumstances,  by  varieties  of  climate, 
season  or  the  state  of  society,  it  is  nearly  co-exten- 
sive with  the  habitable  parts  of  the  globe.  Whe- 
rever the  process  of  putrefaction  is  going  on  to  any 
considerable  extent,  this  poison  may  be  exhaled. 
It  is,  however,  more  frequently  and  copiously  pro- 


224  Introductory  Lecture. 

duced,  and  more  highly  concentrated,  in  warm 
and  tropical  countries  than  in  high  latitudes  and 
frozen  regions.  It  is  commonly  generated  in 
greater  abundance  during  the  heats  of  summer, 
and  operates  more  perniciously  in  autumn  than  at 
other  seasons.  It  is  almost  uniformly  found  to 
be  more  copious  and  destructive  in  sea-ports,  in 
situations  along  sea-coasts,  lakes  and  rivers,  in 
plains,  marshes  and  swamps,  or  wherever  stagnant 
waters  are  collected,  than  in  the  interior,  high  or 
mountainous  districts  of  the  country. 

The  effects  vary,  in  degree  of  noxiousness,  as 
remarkably  as  the  sources.  These  miasmata  may, 
therefore,  be  properly  divided  into  mild  and  ma- 
lignant. In  the  one  case,  they  produce  intermit- 
tents  of  a  moderate  and  transient  character ;  in 
the  other,  they  assail  the  human  constitution  by  a 
most  deleterious  influence,  and  spread  havoc  and 
death  in  every  direction. 

In  the  southern  parts  of  Europe,  in  the  East 
and  West-Indies,  and  in  many  other  parts  of  Asia, 
Africa  and  America,  this  malignant  principle 
often  depopulates  cities,  villages,  and  large  dis- 
tricts ;  and  not  unfrequently  converts  whole  coun- 
tries into  scenes  of  mortality  and  desolation. 
There  are  situations  in  all  these  several  parts  of 
the  world  (and  the  number  of  them  indeed  is  not 
small)  in  which  no  human  being  can  remain  for  a 


Introductory  Lecture.  225 

few  hours,  without  the  certainty  of  contracting  a 
violent,  and  generally  a  fatal  disease. 

It  would  not  be  difficult  to  mention  places,  pos- 
sessing every  blessing  of  nature  but  a  wholesome 
air,  which  this  poison  renders  nearly  uninhabitable. 
Brindisi,  the  ancient  Brundusium,  a  city  of  Naples, 
near  the  entrance  of  the  Adriatic,  is  of  this  de- 
scription. It  was  formerly  large  and  flourishing ; 
and  may  still  be  considered  as  a  great  city,  if  the 
extent  of  its  walls  only  be  regarded  ;  but  the  in- 
habited houses  do  not  occupy  above  half  the  en- 
closure. The  port  is  the  finest  in  the  Adriatic. 
Fertility  of  soil,  depth  of  water,  safety  of  anchor- 
age, and  a  central  advantageous  position  are  all 
united  at  this  place  ;  and  yet  it  has  neither  com- 
merce, husbandry  nor  populousness.  In  conse- 
quence of  obstructions  in  the  channel,  this  excel- 
lent port  was  converted  into  a  stagnant,  fetid  and 
green  lake,  full  of  putrid  and  noxious  matter. 
Some  low  grounds  in  the  vicinity  were  also  over- 
flown ;  and  all  together  produced  annually  a  mor- 
tal pestilence,  which  destroyed  or  drove  away  the 
largest  portion  of  the  inhabitants.  From  18,000, 
they  were  reduced  to  5,000  emaciated,  ghastly, 
livid  wretches,  tormented  with  agues  and  malig- 
nant feviers,  dying  daily  in  great  numbers,  and 
without  a  hope  of  improving  their  situation. — If 
proofs  or  examples  were  necessary  on  this  sub- 
ject, it  would  be  easy  to  present  many  more  of 

2  F 


226  Introductory  Lecture. 

them,  equally  striking,  in  all  the  four  quarters  of 
the  globe. — And  such  as  are  desirous  to  see  this 
subject  described  with  all  the  force  and  imagery 
which  the  mind  of  a  poet  can  confer,  may  find  in- 
stances of  the  most  impressive  kind  drawn  from 
nature,  in  Virgil,  Ovid  and  Lucretius. 

The  other  species  of  Miasmata^  mentioned  as 
the  second  in  the  division,  requires  some  addi- 
tional observations.  This  febrile  poison,  as  was 
stated  before,  is  generated  in  the  dwellings  of  in- 
digence and  misery,  or  wherever  human  beings 
are  unduly  crowded  together,  and  denied  the 
blessings  of  ventilation  and  cleanliness.  Hence, 
the  disease  which  it  produces  is  often  found  in 
poor-houses,  hospitals,  barracks,  camps,  jails  and 
ships.  In  all  these  situations,  the  best  means  of 
arresting  the  evil,  such  as  separation,  ablution, 
ventilation  and  cleanliness,  at  the  same  time  plainly 
demonstrate  the  origin  of  it. 

The  disease  produced  by  these  miasmata,  is  that 
denominated  Typhus;  much  spoken  of  in  this 
country,  but  not  often  seen  in  its  genuine  charac- 
ter. Happily  for  the  United  States,  the  condition 
of  society,  and  the  comforts  and  resources  even  of 
the  most  indigent  class  of  people,  are  such,  with  a 
few  exceptions  in  some  of  our  large  cities,  that 
Typhus  can  rarely  prevail  to  any  great  degree. 
"Manufacturing  towns  and  overgrown  cities  are 


Introductory  Lecture.  227 

commonly  the  hot-beds  of  typhous  miasmata;  and 
there  this  disease  generally  prevails  with  a  malig- 
nity and  mortality  truly  pestilential.  The  dwell- 
ings of  the  unhappy  labouring  manufacturers  are, 
for  the  most  part,  in  narrow  streets  and  lanes,  shut 
out  from  the  blessings  of  light  and  air;  and  a 
great  proportion  of  their  habitations  are  cold,  damp 
and  dark  cellars,  where  every  kind  of  filth  is  suf- 
fered to  collect,  because  it  is  impossible  to  make 
such  homes  decent  or  comfortable.  From  naked- 
ness and  want  of  fuel,  the  miserable  inmates  of 
these  dwellings,  of  different  sexes  and  all  ages,  are 
obliged  like  gregarious  animals  to  herd  together 
for  the  purpose  of  retaining  and  imparting  warmth 
to  each  other,  and  making  the  most  of  their  scanty 
supplies  of  clothes  and  covering.  The  wretched- 
ness resulting  from  this  mode  of  living,  and  from 
the  constant  generation  of  typhous  miasmata  which 
it  is  calculated  to  produce,  may  be  more  readily 
conceived  than  described.  We  hope  the  evil  day 
is  still  at  a  great  distance,  when  our  countrymen 
will  be  subjected  to  the  degradation  and  degene- 
racy unavoidably  arising  from  such  a  system  of 
manufactures. 

One  of  the  most  remarkable  and  instructive  in- 
stances of  the  production  of  these  typhous  mias- 
mata, ever  exhibited  to  the  view  of  our  fellow- 
citizens,  is  that  seen  in  the  crowded  and  filthy 
state  of  vessels  arriving  at  our  ports  with  great 


228  Introductory  Lecture. 

numbers  of  passengers  emigrating  from  foreign 
countries,  and  especially  from  the  British  domi- 
nions. A  few  years  ago,  several  examples  of  this 
kind  took  place  in  this  port,  so  destructive  to  the 
unhappy  emigrants,  and  so  shocking  to  humanity, 
that  it  was  deemed  necessary  to  collect  the  facts 
and  lay  them  before  the  public.  And  it  is  confi- 
dently believed  that  this  American  statement  had 
no  small  share  in  impelling  the  British  Parliament 
to  pass  the  statute  for  restraining  and  regulating 
this  enormous  abuse.  That  political,  and  perhaps 
sinister  motives  had  likewise  their  influence  in 
framing  this  statute,  cannot  indeed  be  doubted ; 
but  still  it  is  to  be  hoped  that  the  obligations  of 
humanity  were  not  entirely  overlooked  in  that 
measure. 

After  this  account  of  the  different  sources  of 
Miasmata,  it  becomes  proper  now  to  pass  to  the 
consideration  of  Contagion,  a  most  important 
source  of  diseases,  and  one  which  has  deservedly 
filled  a  great  space  in  modern  medical  disquisi- 
tion. In  ancient  times,  it  is  well  known  that  Poi- 
sons and  Antidotes  occupied  much  not  only  of 
popular  and  medical  attention,  but  that  also  of 
princes  and  the  most  illustrious  statesmen  and 
military  commanders.  An  example  of  this  is  to 
be  found  in  the  eagerness  with  which  Mithridates 
pursued  the  inquiry,  and  the  anxiety  he  displayed 
in  framing  and  improving  a  composition,  fancied 


Introductory  Lecture.  229 

to  possess  the  powers  of  a  universal  antidote,  and 
which  has  descended  to  the  present  time,  still 
bearing  his  name.  The  frequent  use  of  poisons 
in  these  turbulent  and  ferocious  ages  will  readily 
explain  this  fact. 

It  has  been  asserted  that  the  ancients  were  un- 
acquainted with  contagion.  It  is  ascertained  that 
no  reference  to  the  subject  is  to  be  found  in  the 
writings  of  Hippocrates,  Celsus  and  Aretaeus.  It 
is  likewise  clearly  settled,  that  no  physicians  before 
the  Arabians  make  mention  of  epidemics,  except- 
ing such  as  arise  from  localities,  seasons  or  con- 
stitutions of  the  air.  Until  their  time,  the  conta- 
gion of  Small-pox  and  Measles  was  unknown. 
Concerning  Leprosy,  so  often  mentioned  in  Holy 
Writ,  many  doubts  and  disputes  continue  to  the 
present  time.  As  to  Syphilis,  wherever  or  how- 
soever it  may  have  originated,  no  authentic  notice 
of  it  is  to  be  found  till  towards  the  close  of  the 
15th  century. 

Since  the  period  of  the  Crusades,  contagion 
and  the  means  of  arresting  its  progress,  have  ob- 
tained as  much  of  the  attention  of  the  civilized 
world  as  had  been  previously  bestowed  upon  poi- 
sons and  antidotes.  The  havoc  and  terror  which 
were  spread  throughout  Europe  by  the  contagion 
of  the  Small-pox,  will  naturally  account  for  a  great 
share  of  the  impression  made  on  men's  minds  at 


230  Introductory  Lecture. 

that  interesting  period.  The  effects  arising  from 
that  disease  obviously  explain  the  tendency  uni- 
versally felt  to  extend  the  same  character  to  others 
which  were  by  no  means  entitled  to  it. 

In  more  modern  times,  contagion  has  become 
the  subject  of  much  popular,  as  well  as  medical 
disquisition.  And  it  is  one  of  the  most  conspi- 
cuous improvements  of  the  present  age,  that  the 
former  indefinite  notions  on  this  subject  have 
been  succeeded  by  a  doctrine  more  exactly  cir- 
cumscribed, and  whose  boundaries  are  much  more 
conformable  to  reason,  experience  and  truth. 

Even  in  this  rapid  sketch,  it  would  be  improper 
to  neglect  giving  an  account  of  the  morbid  influ- 
ence and  operation  of  certain  unknown  qualities 
or  constitutions  of  the  atmosphere,  which  prove  a 
fertile  source  of  diseases.  As  one  of  the  most 
striking  examples  of  this  noxious  power,  we  may 
mention  that  common  epidemic  popularly  called 
Influenza,  which  prevails  in  this  city  at  the  present 
time,  and  which  from  its  frequency  and  severity, 
has  become  a  complaint  of  serious  character. 

In  addition  to  the  morbid  causes  already  no- 
ticed, it  becomes  my  duty  to  mention  that  power- 
ful and  prevalent  one  in  this  country,  arising  from 
the  abuse  of  ardent  liquors.  The  blessings  en- 
joyed by  the  labouring  classes  of  our  citizens,  in 


Introductory  Lecture.  231 

the  cheapness  of  subsistence  compared  with  the 
high  price  of  labour,  are  too  often  squandered 
away  for  the  sake  of  indulging  this  pernicious  pro- 
pensity. A  great  proportion  of  all  persons  found 
in  our  hospitals  and  alms-houses,  are  the  victims 
of  sottishness.  I  can  add  nothing  to  the  weight 
of  the  remonstrances  which  have  been  often  pre- 
sented to  the  public,  on  the  morbid  and  corrupting 
consequences  of  this  vice.  For  the  purpose,  how- 
ever, of  refuting  the  vulgar  opinion,  that  spiritous 
liquors  are  useful  in  enabling  people  to  bear  ex- 
treme cold,  it  is  only  necessary  to  state,  that,  in 
all  the  frequent  attempts  to  sustain  the  intense 
cold  of  winter  in  the  arctic  regions,  particularly  in 
Hudson's  Bay,  Greenland  and  Spitzbergen, those 
crews  or  companies  which  had  been  well  supplied 
with  provisions  and  liquors,  and  enabled  thereby 
to  indulge  in  indolence  and  free  drinking,  have 
generally  perished  ;  while,  at  the  same  time,  the 
greatest  number  of  survivors  has  been  uniformly 
found  among  those  who  were  accidentally  thrown 
upon  those  inhospitable  shores,  destitute  of  food 
and  spiritous  drinks,  compelled  to  maintain  an 
incessant  struggle  against  the  rigours  of  the  cli- 
mate in  procuring  food,  and  obliged  to  use  water 
alone  as  drink.  This  fact  is  too  decisive  to  need 
any  comment. 

Upon  the  whole,  it  results  from  the  hasty  view 
of  the  subject  just  now  given,  that  we  are  to  con- 
sider changes  of  temperature,  peculiar  imalutary 


232  Introductory  Lecture. 

constitutions  of  the  air,  miasmata,  contagion,  and 
the  abuse  of  ardent  drinks,  as  forming  some  of  the 
most  distinguished  and  frequently  operative  of  the 
noxious  powers  to  which  the  inhabitants  of  this 
country,  and  indeed,  of  many  other  countries,  are 
exposed.  And  it  is  for  the  purpose  of  preventing 
and  combating  the  host  of  diseases  thence  arising, 
that  all  the  most  strenuous  efforts  of  the  medical 
art  are  to  be  incessantly  directed. 


To  such  persons  as  design  to  devote  themselves 
to  the  practice  of  physic,  as  a  profession,  it  cannot 
surely  be  necessary  to  say  much  for  the  purpose 
of  recommending  the  practical  department  of  this 
science  to  their  especial  attention.  They  cannot 
be  too  soon  apprized,  that  it  is  chiefly  on  the  ac- 
quisition or  neglect  of  practical  knowledge  that 
their  reputation  and  usefulness  as  physicians  will 
ultimately  depend.  This  is  the  knowledge  they 
are  to  carry  with  them  into  the  chamber  of  illness 
and  to  the  bed-side  of  the  sick ;  by  the  aid  of  this 
alone  can  they  be  enabled  to  obtain  that  informa- 
tion often  obscure  and  uncertain,  which  is  all-im- 
portant to  the  framing  of  sound  opinions  ;  on  this 
they  must  rely  for  relief  from  all  the  doubts,  per- 
plexities and  anxieties  incidental  to  difficult  and 
hazardous  cases  ;  by  this  only  can  they  be  assisted 
and  enlightened  in  the  decision  of  the  momentous 
questions,  which  so  frequently  involve  the  safety 


Introductory  Lecture.  233 

•and  life  of  a  fellow-creature  ;  and  finally,  it  is 
solely  by  this  that  they  can  expect  to  sustain  with 
firmness  and  self-approbation,  the  high  responsibi- 
lity they  assume  in  undertaking  to  discharge  all 
the  various  and  complicated  duties  of  this  arduous 
profession. 

With  the  view  of  communicating  this  practical 
instruction  in  the  most  direct  manner,  as  well  as 
testing  the  soundness  of  the  principles  and  doctrines 
which  are  to  be  presented  in  the  ensuing  course, 
the  students  will  have  frequent  access  to  the  wards 
of  the  New- York  Hospital,  where  they  will  con- 
stantly find  a  great  number  of  patients.  In  that 
charity,  they  will  be  conducted  to  the  bed-side  of 
the  sick,  and  enjoy  the  advantage  of  seeing  an  ex- 
perimental illustration  of  the  doctrines  delivered 
from  this  chair.  In  this  course  of  clinical  practice, 
they  will  be  enabled  to  observe  and  judge  for 
themselves;  and  thereby  acquire  the  most  satisfac- 
tory means  of  deciding  whether  they  ought  to 
adopt  or  reject  the  methods  of  treating  diseases 
which  will  be  exhibited  to  their  view.  It  is  uni- 
versally known,  that  whatever  we  see  makes  a 
deeper  and  more  lasting  impression  on  the  mind 
than  what  is  learnt  by  description.  Written  ob- 
servations rarely  strike  us  forcibly  until  we  expe- 
rience their  accuracy  ;  we  read  them  and  receive 
a  feeble  and  fugitive  impression,  unless  we  meet 
with  some  incident  which  verifies  what  we  have 

2  c 


234  Introductory  Lecture. 

read,  and  thereby  brings  it  home  to  the  under- 
standing and  fixes  it  in  the  memory. — There  are 
likewise  many  circumstances  relating  to  diseases, 
and  these  too  extremely  important,  of  which  it  is 
difficult  to  convey  any  just  impression  by  written 
or  oral  description  ;  such  are  the  different  appear- 
ances of  the  countenance,  especially  of  the  eyes, 
the  various  states  of  the  pulse,  respiration,  voice, 
smell,  taste,  different  degrees  of  heat,  and  many 
other  similar  subjects  of  observation.  Hence 
every  experienced  physician,  and  indeed  every 
artist  of  any  profession,  knows  much  more  than 
he  is  able  to  communicate.  Students  of  medi- 
cine, however,  find  diseases  described,  in  systems, 
as  existing  by  themselves ;  but  in  practice  they 
are  found  mixed  and  complicated  in  such  various 
forms,  as  no  description  can  specify,  and  to  which 
no  general  practical  rules  can  be  applied. — It  de- 
serves to  be  considered,  also,  that  a  student,  edu- 
cated in  this  manner,  acquires  the  habit  of  attention 
and  discrimination ;  he  brings  the  truth  of  general 
principles  to  the  test  of  experience  ;  he  discovers 
the  fallacy  of  some  of  them,  and  learns  to  ascertain 
the  numerous  exceptions  and  limitations  to  which 
others  are  subjected  ;  he  often  finds  the  most 
plausible  indications  of  cure  to  be  delusive,  and 
that,  among  the  various  remedies  recommended, 
in  consequence  of  such  indications,  too  frequently 
none  are  sufficient  to  afford  relief.  By  these 
means,  he  acquires  an  early  and  salutary  distrust 


Introductory  Lecture.  235 

of  theories,  however  specious  or  captivating. — To 
this  it  may  be  added,  that  by  such  a  course  of  in- 
struction, he  is  enabled,  further,  to  ascertain  the 
relative  importance  of  the  several  branches  of  me- 
dicine, as  conducive  to  the  main  purpose  of  his 
profession — the  prevention  and  cure  of  diseases, 
and  regulates  his  application  to  them  accordingly. 
It  is  proper  that  a  student  should  be  on  his  guard 
against  wasting  his  time  and  labour  in  pursuits 
which  have  either  no  tendency,  or  at  most  a  re- 
mote one,  to  throw  light  on  the  immediate  objects 
of  his  practice.  Life  is  too  short,  opportunity  too 
fugitive,  and  business  too  urgent  for  every  study 
that  may  be  deemed  ornamental  to  a  physician ; 
they  will  not  even  allow  time  for  every  study  that 
has  a  direct  connection  with  medicine. 

From  what  has  been  said,  it  clearly  results  that 
clitiical  medicine,  or  the  actual  superintendence 
and  observation  of  the  treatment  of  diseases,  as 
they  occur  in  particular  cases,  is  absolutely  and 
indispensably  necessary  to  form  the  true  medical 
character,  and  is  the  almost  exclusive  source  of  ge- 
nuine pathological  and  therapeutic  science.  With- 
out this,  the  most  minute  knowledge  of  anatomy, 
the  most  profound  skill  in  chemistry,  the  most  la- 
borious acquirements  in  the  vast  field  of  natural 
history,  will  be  all  unavailing  when  a  physician  is 
summoned  to  discharge  the  arduous  and  important 
duties  of  his  profession.     In  making  this  remark, 


256  Introductory  Lecture. 

1  hope  not  to  be  misunderstood.  Nothing  is  mors, 
distant  from  my  design  than  to  disparage  the  ne- 
ssary  and  inestimable  branches  of  science  just 
mentioned.  On  the  contrary,  the  utility  of  them 
is  disclosed  more  and  more  every  day  with  each 
step  of  the  advancement  of  medicine.  But  what 
I  am  particularly  anxious  to  inculcate,  is  the  im- 
portance of  watching,  interrogating  and  scrutiniz- 
ing nature,  as  exhibited  in  the  morbid  state,  or,  in 
other  words,  of  acquiring  that  knowledge  of  mor- 
bid physiognomy,  if  I  may  be  allowed  to  say  so, 
which  formed  so  distinguished  a  part  of  the  cha- 
racter of  Hippocrates,  Sydenham,  and  many  others, 
whose  names  are  immortalized  on  the  page  of 
medical  history. 

The  neglect  of  this  acquisition  constitutes,  I 
believe,  one  of  the  most  prominent  degeneracies 
of  modern  medicine.  Notwithstanding  the  great 
advances  of  the  present  age,  the  ancients  still 
maintain  a  decided  superiority  with  respect  to  the 
arts  and  sciences  of  pure  observation.  If  we  di- 
vest ourselves  of  prejudice,  we  are  constrained  to 
believe,  that  it  is  owing  to  the  confidence  inspired 
by  the  more  extended  attainments  of  the  present 
times,  to  the  facility  of  procuring  books  upon  all 
subjects,  and  to  the  practice  of  drawing  almost  all 
our  knowledge  from  this  last-mentioned  source  ; 
that  we  must  attribute  that  deficiency  in  depth, 
originality,  and  justness  of  conception,  which  is 


Introductory  Lecture.  237 

but  too  manifest  in  the  works  of  modern  observ- 
ers. A  great  part  of  their  time  being  spent  in 
reading,  they  seldom  view  with  their  own  eyes 
what  the  real  observer  sees  in  nature  ;  for  the 
truths  which  it  costs  so  much  trouble  to  extort 
from  nature,  are  easily  found  in  books.  The 
advantages,  in  other  respects  so  important,  which 
result  from  the  quick  diffusion  of  knowledge,  are 
attended  with  this  inconvenience,  that  the  im- 
provement of  the  mind,  with  regard  to  the  extent 
of  its  acquirements,  is  often  counterbalanced  by 
the  loss  it  sustains  in  respect  of  the  force  and  per- 
manence of  its  conceptions  ; — that  the  memory  of 
words  is  often  enlarged  at  the  expense  of  the 
memory  of  facts; — and  that  we  often  neglect  ob- 
jects which  may  be  seen  and  examined  by  our- 
selves, in  order  to  inquire  what  has  been  imagined 
and  said  by  others. 

But,  if  this  be  one  of  the  disadvantages  of  the 
present  state  of  knowledge,  we  are  abundantly  con- 
soled by  the  view  of  things  in  a  different  direction. 
It  is  our  happiness  to  live  in  an  enlightened  and 
inquisitive  age.  The  history  of  the  human  mind 
during  the  last  thirty  years  is  crowded  with  oc- 
currences equally  interesting,  unexpected  and  im- 
portant. The  sciences  have  undergone  revolu- 
tions so  extensive  and  fundamental,  that  we  may 
truly  say,  they  not  only  wear  a  new  garb,  but  they 
rest  upon  new  foundations.     The  present  period 


238  Introductory  Lecture. 

is  one  of  those  distinguished  eras  in  history,  to- 
wards which  posterity  will  often  look  back  with 
the  deepest  interest,  and  of  which  it  will  expect  a 
just  account  from  all  such  as  have  it  in  their  power 
to  assist  and  accelerate  the  progress  of  knowledge 
in  its  career  of  discovery  and  improvement.  In 
these  great  discoveries  and  improvements,  which 
revolutionize  the  sciences,  it  is  the  lot  of  only  a 
small  number  of  fortunate  individuals  to  partici- 
pate. But  in  the  present  advanced  state  of  know- 
ledge, there  is  no  one  who  may  not,  in  some  de- 
gree, contribute  to  its  progress.  The  facility  of 
communication  and  the  rapidity  of  intelligence 
from  one  portion  of  the  civilized  world  to  another, 
notwithstanding  the  present  temporary  embarrass- 
ments of  intercourse,  have  now  arrived  at  such  a 
state,  that  the  least  real  improvement  in  the  most 
obscure  art  is  quickly  extended  to  all  the  rest,  and 
the  relations  which  have  been  established  between 
the  different  objects  of  our  inquiries  and  labours, 
enable  them  all  to  derive  benefit  from  the  progress 
of  any  one  in  particular.  The  ancients  had,  in- 
deed, a  distant  view  of  these  relations,  and  had 
perceived  that  all  the  arts  and  sciences  were  con- 
nected together,  and  formed,  as  it  were,  a  com- 
plete whole.  But  they  had  remarked,  or  rather 
foretold  this,  by  a  kind  of  intuitive  sagacity,  with- 
out perceiving  the  mode  of  it  distinctly,  and  had 
attempted  to  describe  it,  without  understanding 
the  nature  and  circumstances  of  the  connection. 


Introductory  Lecture,  239 

It  is  only  in  modern  times ; — it  is  only  after  hav- 
ing considered  the  various  efforts  of  human  indus- 
try in  all  their  applications,  and  in  all  the  diiFerent 
directions  which  they  may  assume ; — it  is  only 
after  having  subjected  them  to  rules,  and  com- 
bined them  into  systems,  as  well  as  reduced  them 
into  divisions  and  sub-divisions,  that  we  have 
been  enabled  to  determine  with  accuracy  the  mu- 
tual relations  which  connect  them,  and  the  influ- 
ence which  they  exert,  or  are  capable  of  exerting, 
upon  one  another.  We  now  clearly  see,  and  we 
can  readily  demonstrate,  that  there  is  nothing  in- 
sulated or  unconnected  in  the  labours  of  man ; 
they  are  all  united,  if  the  comparison  may  be 
permitted,  as  nations  are  united,  by  the  ties  of 
commerce  ;  they  mutually  assist  and  depend  upon 
each  other,  like  the  individual  members  of  the  so- 
cial community.  If  this  be  true  as  to  the  sciences 
in  general,  it  is  eminently  so  with  respect  to  me- 
dical science. 

As  medicine  principally  consists  in  the  know- 
ledge of  facts  progressively  accumulated,  it  re- 
sults that  our  endeavours  ought  to  be  diligently 
and  incessantly  directed  to  this  object.  All  im- 
provements in  this  science  are  an  universal  and 
unmixed  good.  They  belong  to  all  ages,  all 
countries,  and  to  all  stages  and  conditions  of  so- 
ciety. The  true  end  of  science  is  the  production 
of  new  powers,  and  the  application  of  them  to  the 


240  Introductory  Lecture* 

greatest  possible  variety  of  useful  purposes.  I 
trust,  therefore,  that  the  students  of  medicine, 
who  may  honour  me  with  their  attendance,  will 
need  no  further  incitements  to  a  diligent  and  inde- 
fatigable pursuit  of  all  the  knowledge  requisite  to 
prepare  them  for  the  profession  they  have  chosen 
to  assume; — that  they  will  perceive  the  weight  of 
obligation  which  they  take  upon  themselves, — 
and  continually  act  under  the  impression  of  this 
high  responsibility ;  and  that  they  will  be  duly  sen- 
sible that  he  who  offers  himself  to  the  public  as 
the  sole  reliance  and  last  hope  of  the  sick,  as  to  this 
world,  without  adequate  qualifications,  is  guilty 
of  a  breach  of  trust  of  the  most  criminal  kind. 
And  shall  we  then,  gentlemen,  who  by  devoting 
ourselves  to  the  alleviation  of  the  sufferings  of 
mankind,  so  frequently  command  the  interests 
that  are  dearest  to  the  human  heart ; — we  who 
from  the  high  importance  of  these  interests  are 
required  to  search  for  information  in  all  quarters, 
and  whose  studies  embrace  almost  all  the  branches 
of  physical  and  moral  research  ; — shall  we  alone 
be  exempted  from  the  duty  of  promoting  the  ge* 
neral  welfare  of  mankind  by  our  labours,  and  of 
contributing  to  the  improvement  of  our  profes- 
sion ?  By  no  means.  Let  us,  therefore,  unite  our 
efforts,  and  endeavour  to  introduce  into  the  study 
and  practice  of  Physic,  that  high  and  refined  de- 
gree of  reason  and  philosophy,  without  which  it  is 
so  far  from  affording  useful  aid,  that  it  becomes  in 
reality  a  public  scourge. 


Introductory  Lecture.  241 

While  we  proceed  with  zeal  and  perseverance 
in  such  a  course  as  this,  there  is  no  doubt  that  we 
shall  enjoy  the  protection  and  patronage  of  the 
Regents  of  the  University,  and  the  approbation  of 
our  country,  whose  opinion  equally  liberal  and 
enlightened,  will  always  bestow  a  due  degree  of 
commendation  on  meritorious  and  faithful  ex- 
ertions in  the  service  of  the  public. 


2  h 


INTRODUCTORY  LECTURE, 


ON   THE 


CERTAINTY  OF  MEDICINE. 


INTRODUCTORY  LECTURE. 

&c.  &c. 


J.  HE  return  of  the  season  of  medical  instruction 
most  agreeably  renews  the  relation  between  this 
Institution  and  the  ingenuous  and  respectable  stu- 
dents who  honour  it  with  their  attendance.  In 
addition  to  this  gratification,  the  second  session  of 
our  College  opens  under  circumstances  more 
auspicious  and  flattering,  than  we  had  reason  to 
anticipate ;  and  certainly  much  more  so,  than  its 
most  sanguine  friends  could  have  believed,  at  the 
first  establishment. 

Many  persons,  who  are  anxiously  concerned 
for  the  progress  of  science,  have  supposed  that 
the  present  unpropitious  state  of  public  affairs, 
arising  from  the  suspension  of  foreign  commerce, 
would  impede  the  course  of  public  instruction  by 


246  Introductory  Lecture. 

keeping  at  home  a  number  of  students,  who,  in  a 
more  prosperous  state  of  the  nation,  might  have 
been  enabled  to  attend  some  of  the  different  med- 
ical seminaries  in  the  United  States.  But  I  trust 
this  temporary  suspension,  although  its  pressure 
must  be  more  or  less  felt  by  every  part  of  the 
community,  will  not  produce,  to  any  extent,  the 
apprehended  mischief.  As  our  country  constantly 
demands  and  deserves  the  services  of  its  citizens, 
we  ought,  in  defiance  of  every  difficulty,  to  be  in- 
cessantly preparing  ourselves  for  the  performance 
of  such  services  with  the  utmost  degree  of  energy 
and  usefulness.  The  approach  of  national  cala- 
mities (if  such  a  destination  should  unhappily 
await  our  country)  ought  to  induce  us,  instead 
of  allowing  the  least  relaxation  of  our  exertions, 
rather  to  redouble  our  diligence  in  acquiring  the 
qualifications  necessary  for  serving  the  public  be- 
neficially in  the  several  professions  in  which  we 
engage.  It  may  be  justly  questioned  whether 
peace  and  tranquillity  (however  desirable  and  pre- 
cious to  every  patriotic  and  humane  breast)  are  in 
all  respects  so  favourable,  and  national  commo- 
tions on  the  contrary  so  adverse  to  education  and 
intellectual  improvement,  as  they  have  been  com- 
monly supposed.  Even  the  multiplied  miseries 
of  war  and  revolution  do  not  appear  to  arrest  the 
progress  of  the  sciences  in  the  degree  to  which  a 
superficial  enquirer  might  be  disposed  to  calculate. 
Examples  of  this  kind  must  be  in  the  recollection 


Introductory  Lecture,  247 

of  all  who  are  in  the  habit  of  recurring  to  the  past, 
for  the  purpose  of  estimating  the  future.  Our 
immortal  Harvey,  the  ornament  of  his  profession, 
whose  discoveries  form  an  era  in  its  history,  was 
never  deterred  from  the  pursuit  of  his  interesting 
inquiries  by  the  rage  of  civil  dissensions,  nor  by 
all  the  ruin  and  destruction  which  the  flames  of 
intestine  war  were  incessantly  producing  around 
him.  With  a  dignified  composure,  he  persevered 
in  his  physiological  investigations  till  he  was  ena- 
bled to  establish  his  principles  and  to  rescue  his 
reputation  from  calumny, — although  by  espousing 
the  unpopular  and  the  finally  unfortunate  cause  of 
his  fallen  sovereign,  he  became  extremely  obnox- 
ious, and  suffered  all  the  obloquy  and  violence  in- 
cidental to  a  prostrate  party. — The  present  state 
of  the  continent  of  Europe  seems  likewise  to  con* 
firm  this  impression.  The  same  observer  who  wit- 
nesses on  one  hand  the  havoc  and  desolations  of 
war,  laying  waste  some  of  the  fairest  portions  of 
the  globe,  is  also,  on  the  other  hand,  compelled  to 
acknowledge  that  the  sciences  never  flourished  to 
a  greater  extent,  and  that  they  were  never  cultiva- 
ted with  more  enlightened  views  or  enriched  with 
more  brilliant  discoveries. 

The  sensations  produced  by  great  events,  and 
the  passions  excited  by  political  emergencies, 
which  involve  the  deepest  interests  of  the  commu, 
nity,  will  be  generally  found  to  invigorate  the  ope. 


248  Introductory  Lecture, 

rations  of  the  mind  on  whatever  subject  it  may  bt 
employed.  We  cannot,  therefore,  admit  the  appre- 
hension, that  the  present  lowering  aspect  of  public 
affairs,  nor  the  dread  of  impending  calamities  still 
more  serious,  can  ever  materially  impede  the  pro- 
gress of  public  instruction,  or  extinguish  that  ar- 
dour in  the  pursuit  of  science,  which  now  glows 
so  warmly  in  the  American  mind. 

It  is  matter  of  gratification  to  every  member  of 
our  Institution,  to  consider  the  relation  between 
this  seminary  and  its  pupils,  as  highly  interesting, 
and  calculated  to  produce  consequences  of  great 
importance.  To  those  who  are  engaged  in  con- 
ducting the  system  of  instruction,  this  relation  is 
extremely  important,  not  only  as  it  involves  duties 
of  high  obligation  and  responsibility,  imposed  by 
the  authority  of  government,  and  in  which  the 
community  is  deeply  concerned, — but  likewise,  as 
the  task  of  teaching,  when  properly  pursued,  is 
inseparably  connected  with  that  of  acquiring 
knowledge  on  the  part  of  the  teacher  himself.  To 
the  students  who  attend  for  the  purpose  of  receiv- 
ing instruction,  this  relation  must  be  considered 
as,  at  least,  equally  important.  On  the  due  em- 
ployment of  the  opportunities  for  improvement 
which  they  here  possess,  will  depend  much  of 
their  reputation  and  success  in  their  profession, — 
much  of  their  capacity  for  improvement  in  future, 
:md  much  of  that  self-approbation  and  tranquillity 


Introductory  Lecture,  249 

which  a  punctual  and  conscientious  discharge  of 
duty  alone  can  confer. 

On  the  importance  and  utility  of  the  medical 
profession,  it  is  not  necessary  now  to  dwell.  Every 
member  of  society  is  more  or  less  interested  in  it, 
for  every  person  has  health  either  to  preserve  or 
to  regain.  The  esteem  in  which  the  guardians 
of  health  have  been  held  in  all  ages,  is  a  practical 
and  convincing  proof  of  the  effectiveness  and  uti- 
lity of  medicine  ;  for  respectability  and  confidence 
will  not  ordinarily,  with  the  general  consent  of 
mankind,  continue  long  to  be  materially  misplaced. 

It  is  requisite,  for  the  purpose  of  cultivating 
medicine  with  ardour,  that  it  should  be  considered 
as  consisting  of  sound  and  fixed  principles,  and 
founded  upon  a  solid  basis.  The  uncertainty  and 
inutility  of  it  is  the  favourite  cant,  among  men  who 
enjoy  robust  and  uninterrupted  health,  among  in- 
curable patients,  and  among  that  portion  of  our 
fraternity  who  avail  themselves  of  it  as  a  shelter 
from  the  reproach  of  their  ignorance  and  blunders. 
If  the  charge  were  heard  only  from  such  persons 
as  these,  there  would  be  no  need  of  serious  vindi- 
cation. But  many  philosophers  of  reputation  have 
regarded  medicine  as  a  deceitful  art,  whose  domi- 
nion over  our  minds  is  founded  solely  on  credu- 
lity and  weakness.  As  this  question  concerning 
the  soundness  and  certainty  of  medical  principles 

2  i 


2i>0  Introductory  Lecture, 

has  been  often  agitated,  and  is  really  very  impor* 
taut,  it  will  not  be  amiss  to  glance  for  a  moment 
at  the  leading  topics  in  the  discussion. 

The  cavillers  against  the  solidity  of  medical 
science  have  endeavoured  to  justify  their  opinions 
on  some  of  the  following  grounds. 

They  maintain,  that  the  principle  of  animal  life 
is  enveloped  in  so  much  mystery  and  darkness,  as 
to  elude  the  utmost  force  of  inquiry  ;  and  that  of 
consequence  we  are  left  in  hopeless  ignorance  of 
the  subject  on  which  we  are  incessantly  called  to 
operate,  and  the  explanation  of  which  ought  to 
constitute  the  foundation  of  our  knowledge.  The 
secret  springs  of  life  are,  in  reality,  concealed  from 
observation,  and  we  can  form  no  precise  idea  ei- 
ther of  the  power  which  animates  our  bodies,  or 
of  the  means  by  which  the  influence  of  this  power 
is  exercised.  This  is  indeed  too  evident  from  the 
slow  progress  hitherto  made  in  the  investigation  of 
this  principle,  though  men  well  qualified  by  their 
abilities,  learning  and  experience,  have  for  more 
than  two  thousand  years  been  communicating  to 
the  world  ail  they  could  add  by  means  of  just  rea- 
soning, to  the  mass  of  facts  collected  by  diligent 
observation.  Whoever  applies  himself  to  the  stu- 
dy of  nature,  must  own  we  are  yet  greatly  in  the 
dark  in  regard  even  to  inert  matter,  and  that  we 
know  but  little  of  the  properties  and  powers  of 


Introductory  Lecture.  251 

the  inanimate  creation.  But  we  have  all  this  ob- 
scurity to  perplex  us  in  studying  animated  nature, 
with  the  addition  of  a  vast  deal  more,  arising  from 
the  unknown  peculiarities  of  life. 

If  an  intimate  knowledge  of  the  nature  of  vi- 
tality were  necessary  to  serve  as  the  basis  of  the 
healing  art,  the  art  itself  would  fail  in  its  essential 
and  fundamental  principle.  The  question  then  is 
reduced  to  this, — whether  it  be  absolutely  neces- 
sary for  the  useful  practice  of  physic,  to  be  enabled 
to  penetrate  into  the  essence  of  the  vital  powers, 
and  to  form  a  precise  notion  of  their  mode  of  ope- 
rating on  the  human  body. 

To  this  question,  we  reply  decidedly  in  the 
negative.  Man  knows  the  essence  of  nothing; 
neither  of  matter,  which  is  always  before  his  eyes, 
nor  of  those  secret  principles  which  actuate  and 
determine  all  the  phenomena  of  the  universe.  He 
is  often  occupied  with  the  consideration  of  causes, 
which,  he  flatters  himself,  he  has  discovered,  and 
of  others  which  he  feels  and  laments  his  inability 
to  ascertain ;  but  first  causes  are  entirely  with- 
held from  his  sight.  He  sees  effects,  or,  rather,  he 
receives  impressions  ;  he  is  constantly  observing 
new  relations  ;  he  arranges  them,  in  order  to  fix  the 
recollection  of  them  in  his  mind  ;  to  appreciate 
them  better,  and  to  draw  from  them  whatever 
may  contribute  to  his  preservation,  or  afford  him 


252  Introductory  Lecture. 

additional  enjoyment : — this  is  the  sum  and  sub- 
stance  of  human  knowledge. 

It  is  worth  considering,  how  far  the  knowledge 
of  first  causes ',  in  the  pursuit  of  which  so  many  pro- 
found lucubrations  have  been  uselessly  expended, 
is  really  applicable  to  the  condition  and  wants  of 
mankind.  Is  it  necessary  for  the  mariner  to  pos- 
/  sess  a  scientific  theory  of  the  winds,  to  enable  him 
!  to  obtain  the  full  effect  of  their  impulse  in  traversing 
the  ocean  ?  or  must  he  understand  the  cause  of 
the  tides,  in  order  to  avail  himself  of  their  aid  in 
ascending  a  river  ?  Must  the  brewer,  the  baker 
and  the  tanner  understand  the  doctrines  of  che- 
mistry, on  which  their  respective  arts  are  founded, 
before  they  are  enabled  to  conduct  them  with 
practical  success?  Is  it  indispensable  that  the 
principles  of  vegetable  life  and  nutrition  should  be 
extorted  from  nature  and  distinctly  understood, 
before  agriculture  can  be  practised  with  advantage, 
or  made  to  yield  sustenance  to  the  animal  world? — 
This  surely  cannot  be  asserted.  It  is  allowed  to 
man,  in  his  present  state,  to  observe  facts,  and  to 
make  the  best  inductions  from  them  he  can ;  this 
is  sufficient  for  him  ;  he  knows  nothing  of  the  na- 
ture of  causation. 

The  phenomena  of  health  and  disease,  the  ef- 
fects of  aliments  and  remedies,  all  come  under  the 
cognizance  of  our  senses,  and  we  draw  rules  from 


Introductory  Lecture.  253 

them  which  are  necessary  for  the  practice  of  our 
art.  We  may  therefore  conclude  that  this  objec- 
tion to  the  certainty  and  firmness  of  our  principles, 
is  not  well  founded.  As  the  want  of  knowing 
causes  is  not  peculiar  to  medical  science,  if  the 
reproach  of  uncertainty  and  conjecture  can  thence 
be  applied  to  it  with  any  truth,  the  principles  of 
almost  all  the  other  sciences  are  exposed  to  a 
similar  charge. 

Another  objection  to  the  certainty  of  medical 
principles,  is  derived  from  our  ignorance  of  the 
nature  and  proximate  causes  of  diseases.  This,  in 
effect,  is  only  a  repetition  of  the  former  objection 
in  different  words.  We  are  acquainted  with  the 
nature  and  causes  of  diseases,  so  far  as  they  can  be 
manifested  to  our  senses  by  the  observation  of 
facts.  We  know  that  the  irritation  of  the  san- 
guiferous system,  denominated  fever,  produces 
certain  changes,  or  rather,  by  certain  changes  is 
made  known  to  us,  and  that  it  is  only  by  these 
changes  that  its  existence  can  be  ascertained. 
When  a  person  coughs,  breathes  with  difficulty, 
feels  pain  in  some  part  of  the  chest,  and  is  affected 
at  the  same  time  with  fever,  we  pronounce  that  he 
labours  under  Pneumonia.  If  it  be  demanded 
what  is  Pneumonia,  we  reply,  it  is  a  disease  in 
which  these  several  circumstances  are  combined. 
If  one  or  more  of  these  circumstances  be  wanting, 
it  is  not  Pneumonia,  or  at  least  not  a  true  example 


254  Introductory  Lecture* 

of  what  is  commonly  designated  by  that  title  j 
therefore  it  is  the  concurrence  of  these  circum- 
stances which  constitutes  the  disease.  The  word 
Pneumonia  only  exhibits  them  in  an  abridged 
form  ;  the  word  is  nothing  of  itself ;  it  expresses 
an  abstract  idea,  and  represents  by  a  single  cha- 
racter all  the  images  of  a  large  picture.  When, 
therefore,  we  are  not  satisfied  with  knowing  a 
disease  by  what  it  presents  to  our  senses,  but 
enquire  what  is  its  real  nature,  what  is  its  es- 
sence,— we  do  little  more  than  ask,  what  is  the 
nature  and  essence  of  a  word,  of  a  simple  abstrac- 
tion. It  is  far,  then,  from  being  correct,  to  assert 
with  an  air  of  positiveness  and  triumph,  that  phy- 
sicians are  altogether  ignorant  of  the  nature  of  fe- 
ver and  many  other  morbid  conditions  of  the  sys- 
tem ;  and  that  they  not  only  judge  and  act  at  ran- 
dom, but  often  employ  agents  whose  essential 
properties  are  entirely  unknown.  With  regard, 
indeed,  to  the  precise  changes  which  the  principle 
of  vitality  undergoes  in  taking  on  a  morbid  dis- 
position, they  are  confessedly  unknown ;  since 
they  are  necessarily  involved  in  all  the  obscurity 
which  belongs  to  the  vital  principle  in  the  state  of 
health.  But  the  causes  and  circumstances  which 
are  obviously  connected  with  the  disease,  and 
make  part  of  its  history,  are  facts  within  the  pow- 
er of  observation ;  they  may  be  discovered  and 
laid  hold  of  by  our  senses ;  they  may  be  commu- 
nicated by  faithful  relation ;  and  as  they  occasion 


Introductory  Lecture.  255 

Gertain  definite  phenomena  in  the  animal  econo- 
my, we  accustom  ourselves  to  recognise  them, 
and  to  draw  from  them  inferences  to  guide  our 
practice. 

The  uncertainty  of  the  principles  of  medical 
science,  has  also  been  positively  inferred  from  the 
fact,  that  diseases  are  so  various  and  so  suscep- 
tible of  complication,  as  to  render  it  impossible  for 
the  most  accurate  observer  to  lay  down  rules  by 
which  others  can  always  discover  and  disentangle 
them  ; — that  they  undergo  so  many  modifications 
from  age,  sex,  temperament,  climates,  season, 
state  of  the  atmosphere,  mode  of  living,  occupa- 
tion, and  previous  complaints,  and  are  so  much 
influenced  by  the  state  and  passions  of  the  mind, 
that  it  is  impossible,  amidst  so  many  various  and 
conflicting  causes,  to  assign  to  each  its  proportion 
of  agency,  to  attribute  to  each  phenomenon  its  just 
value  and  natural  place,  or  to  form  a  suitable  plan 
of  treatment,  or,  finally,  to  draw  inferences  so  cer- 
tain and  conclusive  as  to  be  worthy  of  that  impor- 
tance and  dignity  which  the  healing  art  has  always 
claimed. 

Every  reflecting  physician,  who  understands 
and  candidly  appreciates  the  difficulties  of  his  art, 
will  be  ready  to  acknowledge  that  there  is  much 
force  in  this  objection.  It  is  important  to  be  duly 
aware  of  these  difficulties,  for  the  purpose  of  being 


256  Introductory  Lecture. 

enabled  to  devise  the  best  means  to  obviate  and 
remove  them.  We  are  obliged,  indeed,  continu- 
ally to  admit  exceptions  to  the  rules  laid  down  to 
guide  our  conduct.  It  is  to  be  lamented,  that 
there  is  so  little  in  the  application  of  such  rules, 
or  in  the  plans  of  treatment  which  they  enjoin, 
that  can  be  considered  as  fixed  or  invariable. 
With  the  exception  of  some  general  principles, 
which,  in  consequence  of  their  general  nature,  are 
little  adapted  for  use  in  the  details  of  particular 
cases,  it  seems  as  if  the  theoretical  knowledge  of 
a  physician  were  nearly  reduced  to  nothing  at  the 
bed-side  of  the  sick  ;  so  that  his  practical  skill  ap- 
pears chiefly  to  reside  in  a  sort  of  instinctive 
acuteness,  improved  by  observation  and  experi- 
ence. It  requires  a  vivid  conception  to  penetrate 
a  disease  at  a  single  glance,  and  to  lay  hold  of  all 
its  characters  at  once.  In  morbid  actions,  how- 
ever, the  principal  phenomena  may  be  reduced  to 
a  few ;  most  of  them  resulting  from  the  combina- 
tion and  the  different  degrees  of  intensity  of  a 
small  number.  The  order  in  which  they  occur, 
their  relative  degrees  of  force  and  importance  in 
the  animal  economy,  are  sufficient  to  give  rise  to 
all  the  varieties  of  diseases  ;  in  the  same  manner  as 
a  few  signs  produce  the  finest  compositions  of 
music,  and  a  small  number  of  sounds  make  up  all 
the  wonderful  complications  of  language. 

The  objectors  to  the  certainty  of  medical  priii 


Introductory  Lecture.  257 

ciples  have  likewise  contended,  that  the  nature  and 
properties  of  the  substances  employed  as  remedies 
are  very  little  understood ;  that  their  mode  of 
operating  upon  the  living  body  is  still  more  un- 
known ;  and  that  there  is  scarcely  any  probability 
of  clearing  up  this  obscurity. 

In  answer  to  this,  it  may  be  maintained,  that 
there  appears  to  be  no  necessity,  and  indeed  but 
little  advantage  in  knowing  the  peculiar  proper- 
ties of  the  peruvian  bark,  in  order  to  observe  its 
specific  virtues  in  the  cure  of  intermittents  ;  and 
that  it  would  probably  avail  us  but  little  to  ascer- 
tain the  nature  of  antimony  and  mercury  so  far  as 
to  explain  in  what  manner  the  former  excites  vo- 
miting, and  the  latter  destroys  the  poison  of  sy- 
philis. By  observation  and  experience  we  gain  a 
knowledge  of  the  powers  of  these  remedies,  and 
a  more  minute  acquaintance  with  them  would 
scarcely  render  the  facts  belonging  to  their  history 
more  certain,  or  connect  them  together  in  a  better 
order. 

The  distrust  of  medical  principles  has  been 
further  increased  by  observing  the  difficulties, 
doubts  and  fallacies  which  so  remarkably  attend 
every  step  of  medical  experience.  The  effect  of 
a  particular  remedy,  however  well  ascertained, 
may  depend  upon  a  multitude  of  causes  which  the 
physician  cannot  possibly  detect.     The  silent,  yet 

2  K 


J  5  8  Introductory  Lecture. 

incessant  operation  of  that  restoring  power,  deno- 
minated vis  medicatrix,  always  tending  to  re-es- 
tablish order  in  organized  bodies  ; — the  progress 
of  the  disease  itself,  whose  nature  and  course  may 
not  be  rightly  understood  ; — the  changes  produ- 
ced in  the  corporeal  or  mental  condition  of  the 
patient,  or  in  the  external  circumstances  around 
him  ; — all  these,  and  many  other  things  are  liable 
to  impose  on  the  soundest  and  most  guarded  judg- 
ment, and  to  lead  a  physician  to  attribute  his  suc- 
cess to  a  series  of  combinations,  the  operation  of 
which  is  directly  the  reverse  of  what  he  imagines. 
Hence  inexhaustible  sources  of  error,  both  for  the 
art  itself,  and  for  him  who  exercises  it. — A  cure 
follows  the  application  of  a  remedy  ;  the  remedy 
therefore  has  produced  the  cure, — "  post  hoc,  er- 
go propter  hoc. ' '  This  is  undoubtedly  a  specimen 
of  very  bad  reasoning  in  medicine ;  yet  by  such 
a  fallacious  rule  as  this,  all  the  articles  of  the  Ma- 
teria Medic  a  have  been  brought  into  use,  have 
been  arranged,  and  the  method  of  administering 
different  remedies  has  been  reduced  to  a  system. 
Nothing  demands  more  enlightened  understand- 
ing, mere  caution  and  discrimination  than  the  dis- 
covery of  truths  of  this  kind  ; — for,  in  inquiries 
after  them,  nothing  is  easier  than  to  be  led  astray, 
even  whilst  pursuing  the  right  path  of  investiga- 
tion ; — nothing  more  uncertain  than  the  proofs 
upon  which  our  results  are  supposed  to  rest,  at  the 


Introductory  Lecture.  259 

very  time  when  we  think  we  have  obtained  such 
as  are  perfectly  sure. 

The  uncertainty  and  fallacy  of  experience  in 
medical  researches  undoubtedly  open  an  inex- 
haustible source  of  error  at  every  step  of  the  phy- 
sician's progress  in  the  pursuit  of  truth.  If  any 
operation  of  the  mind  requires  the  possession  and 
exercise  of  all  its  best  faculties,  it  is  unquestion- 
ably that  of  determining,  from  the  symptoms  of  a 
disease,  the  best  indications  of  cure,  estimating  the 
powers  and  effects  of  remedies,  and  establishing 
rules  for  whatever  emergencies  may  take  place  in 
future.  With  all  its  imperfection  and  uncertainty, 
medicine  can  still  justly  claim  a  body  of  principles 
and  doctrines  eminently  entitled  to  confidence.  If 
we  could  suppose  it  to  be  otherwise,  and  believe 
it  incapable  of  being  reduced  to  rules  and  princi- 
ples, it  would  be  unlike  all  other  arts  ;  those  who 
practise  it  would  degenerate  into  a  herd  of  vision- 
aries,  empirics  and  impostors,  and,  instead  of  be- 
ing protected  and  fostered,  they  ought  not  even  to 
be  tolerated  by  a  wise  government. 

While  the  subject  of  medical  experience  is 
under  consideration,  it  may  not  be  improper,  (as 
mistaken  opinions  concerning  it  are  more  or  less 
prevalent  among  all  classes  of  people,)  to  offer 
some  observations  on  the  medical  law  of  evidence, 
This  becomes  the  more  expedient,  as  every  person 


260  Introductory  Lecture. 

ought  to  be  placed  on  his  guard  against  the  de- 
ceptions which  ever)-  where  abound  on  this  point, 
and  more  especially  as  physicians  are  often  accu- 
sed of  a  culpable  incredulity  and  indifference  to 
improvements  in  the  treatment  of  diseases,  when 
they  hesitate  to  believe  the  stories  of  wonderful 
remedies,  and  wonderful  cures  which  are  so  fre- 
quently propagated  in  every  community,  and  often 
gain  belief  in  the  minds  of  judicious  and  respect- 
able men. 

As  the  human  body  is  a  machine  of  such  sin- 
gular intricacy  and  complication, — as  the  diseases 
to  which  it  is  liable  are  so  numerous,  diversified, 
and  still  so  much  involved  in  doubt  and  obscu- 
rity,— as  the  powers  and  uses  of  the  remedies  em- 
ployed in  the  cure  of  these  diseases  are  so  imper- 
fectly understood, — and  as  from  these  several 
sources  collectively,  such  a  vast  amount  of  mis- 
apprehension and  misstatement  must  be  incessantly 
arising ; — it  ought  to  create  no  surprise  to  find  that 
the  evidence  which  is  requisite  to  prove  or  disprove 
any  proposition  in  the  science  of  medicine,  is  of  a 
peculiar  kind.  It  differs  entirely  from  that  species 
of  proof  which  satisfies  a  court  of  law.  Both  di- 
rect and  circumstantial  evidence,  which  would 
leave  no  doubt  in  the  breasts  of  judges  and  juries, 
often  have  not  the  slightest  tendency  to  render  a 
medical  fact  even  probable.  The  declarations,  and 
even  the  oaths  of  the  most  conscientious,  disinte- 


Introductory  Lecture.  261 

rested  and  discerning  men,  are  all  entirely  insuffi- 
cient. 

The  reason  of  this  is,  that  few  men,  even  those 
of  considerable  intelligence,  distinguish  accurately 
between  opinion  and  fact. 

When  a  man  asserts  he  has  been  cured  of  a  par- 
ticular disease  by  a  certain  remedy,  he  is  apt  to 
think  he  is  declaring  a  fact,  which,  as  coming  un- 
der his  own  observation,  and  experienced  in  his 
own  person,  he  knows  to  be  undeniably  true ; 
whereas  this  assertion,  simple  and  unequivocal  as 
it  may  appear  at  first  sight,  includes  two  opinions, 
in  both  of  which  he  may  be  completely  mistaken. 
The  first  is  an  opinion  of  his  having  had  the  dis- 
ease specified ;  the  second,  that  the  medicine  em- 
ployed removed  the  disease.  While  the  ablest 
men  of  the  profession  are  so  liable  to  mistake  in 
forming  opinions  of  this  sort,  it  will  not  be  thought 
strange  that  others  should  be  much  more  so ;  and 
it  is  plain  that  a  mistake  in  either  of  the  opinions 
stated,  must  totally  invalidate  the  whole  assertion. 
Most  people,  indeed,  are  convinced  that  they  are 
acquainted  with  the  malady  they  are  afflicted  with; 
they  consider  it  as  a  mere  matter  of  fact ;  and 
when  they  are  cured,  they  have  as  little  doubt  of 
the  remedy  that  accomplished  it.  This  belief  is 
often  strengthened  by  the  confident  declarations 
and  specious  behaviour  of  the  person  who  exhibits 


262  Introductory  Lecture. 

the  remedy  ;  and  if  the  patient  possess  gratitude, 
this  also  increases  the  impression  and  heightens 
the  delusion.  He  is  thus  easily  prevailed  upon  to 
swear  positively,  both  to  the  disease  and  the  re- 
medy, as  if  they  were  plain  facts,  obvious  to  the 
senses,  and  exempt  from  possibility  of  mistake  ; 
whereas  both  the  one  and  the  other  are  frequently 
beyond  the  reach  of  human  knowledge. 

Instances  of  this  delusion  are  often  presented  to 
the  public  in  certificates  and  affidavits  concerning 
the  cure  of  consumption,  gout,  hydrophobia  and 
other  intractable  distempers.  This  species  of  un- 
intentional fraud  or  perjury  has  become  exceed- 
ingly common  of  late  years  in  every  part  of  Europe 
and  the  United  States ;  and  the  more  improbable 
the  fact  is,  the  more  numerous  are  the  certificates 
or  affidavits,  and  the  more  respectable  the  signa- 
tures. Judges,  clergymen,  and  many  other  esti- 
mable members  of  society,  are  frequently  attesting 
that  themselves  or  their  neighbours  have  been 
cured  of  incurable  diseases,  or  have  derived  signal 
benefit  from  the  use  of  some  insignificant  or  dan- 
gerous nostrum ;  but,  however  benevolent  or  up- 
right the  intentions  of  these  gentlemen  may  be, 
they  ought  to  be  plainly  informed  that  the  fact  in 
question  will  not  be  considered,  by  any  person 
competent  to  examine  the  subject,  as  rendered 
in  any  degree  more  probable  by  this  positive  tes- 
timonial. 


Introductory  Lecture,  263 

But,  to  return  to  the  question  of  certainty  in 
the  principles  of  medical  science. — It  has  been 
contended  by  those  who  deny  any  degree  of  cer- 
tainty in  the  doctrines  of  our  profession,  that  if 
they  were  well  founded,  theory  would  at  all  times 
be  the  same ;  that  the  practice  too  of  one  age 
would  not  materially  differ  from  that  of  another ; 
that  ancient  and  modern  physicians,  men  of  all 
schools  and  all  countries,  would  agree  at  least 
upon  some  important  points ;  whereas,  in  running 
over  the  history  of  medical  opinions,  it  is  wonder- 
ful to  find  such  a  difference  in  their  views,  such  a 
contrariety  in  their  modes  of  treating  diseases. 

Nothing  has  contributed  more  to  withdraw  the 
confidence  of  society  from  the  medical  profession, 
than  the  fluctuating  and  transitory  character  of 
medical  theories.  The  keenest  shafts  of  wit  and 
ridicule  have  often  been  levelled  at  this  trait  of 
everlasting  inconstancy.  But  it  seems  to  have 
been  forgotten,  that  physic,  like  the  other  sciences 
founded  on  experience,  is  continually  progressive, 
and  therefore  subject  to  perpetual  change ;  so  that, 
without  the  suggestions  of  vanity  or  an  unwarrant- 
able desire  of  innovation,  we  may  sometimes  be 
tempted  to  differ  from  our  venerable  predecessors. 
The  origin  and  growth  of  theoretical  opinions  suf- 
ficiently explain  their  fugitive  character.  Every 
step  of  experience  approaches  towards  system  ; 
for,  by  observing  the  apparent  relations  of  things, 


264  Introductory  Lecture. 

as  they  are  presented  to  our  view,  we  are  invo- 
luntarily led  to  the  establishment  of  principles. 
And  theory,  or  the  application  of  these  principles 
to  explain  the  phenomena  around  us,  is  the  natu- 
ral and  favourite  process  of  the  human  mind. 
This  employment,  so  congenial  and  delightful, 
does  not  allow  us  to  wait  the  preparation  neces- 
sary for  its  exact  performance ;  and  our  eager- 
ness impels  us  to  anticipate  the  principles  which 
yet  remain  to  be  discovered.  The  bewildering 
gleams  of  fancy  are  mistaken  for  the  luminous 
rays  of  science  ;  we  are  led  astray  by  the  fantastic 
delusion,  and  pursue  it  through  all  the  fanciful 
and  treacherous  paths  of  hypothesis. 

Things  which  appear  at  first  sight  to  be  natu- 
rally related,  present  themselves  in  a  certain  order 
to  the  view  of  the  observer  ;  but  he  does  not  im- 
mediately discover  that  order  which  is  permanent 
and  invariable.  Amidst  the  variety  of  circum- 
stances which  surround  any  fact,  to  seize  that 
whereon  it  necessarily  depends,  requires  much 
closeness  of  attention,  and  commonly  much  vari- 
ety of  experience.  But  the  mind  will  follow,  in 
the  mean  time,  its  leading  propensity  ;  and  thus 
theories  are  produced,  adopted,  afterwards  inva- 
lidated, and  finally  destroyed  by  successive  ob- 
servation. 

Theory  has  so  often  sunk  beneath  the  stroke  of 


Introductory  Lecture.  265 

experience,  that  we  have  been  led  to  imagine  a 
natural  enmity  between  them  ;  which  by  an  easy 
transition  is  extended  to  their  several  authors  and 
patrons.  Hence  Theorist  and  Empiric,  are  in 
medicine,  terms  of  mutual  reproach,  and  serve  to 
designate  two  opposite  parties,  as  much  as  any  of 
the  opprobrious  distinctions  which  take  place  in 
the  political  world. 

It  must  be  confessed,  indeed,  that  medical  wri- 
ters are  often  divided  in  their  principles,  and  that 
practitioners  are  often  equally  so  in  their  plans  of 
treatment.  Systems  of  speculation  have  risen  up 
and  fallen  in  quick  succession ;  and  even  the 
modes  of  treating  diseases  can  plead  no  exemp- 
tion from  this  instability. 

But  an  intimate  acquaintance  with  the  ancient 
writers,  an  attentive  examination  of  different 
modes  of  practice,  and  an  accurate  survey  of  the 
operations  of  nature,  will  enable  us  to  obviate 
many  of  these  objections,  and  to  reconcile  many 
apparent  contradictions,  With  regard  to  theo- 
retical opinions,  founded  not  simply  upon  facts 
themselves,  but  upon  the  manner  in  which  they 
are  arranged  and  combined,  it  signifies  little  how 
they  disagree,  provided  practice  is  regulated  by 
facts,  and  never  forsakes  the  indications  which 
they  furnish.  The  mathematical,  the  humoral, 
the  chemical  and  the  spasmodic  physicians,  all 

2  r- 


266  Introductory  Lecture. 

agreed,  to  a  considerable  degree  in  their  practical 
inferences,  and  only  employed  their  theories  to 
connect  their  doctrines  together.  From  the  time 
of  Hippocrates  to  the  present  day,  intelligent  prac- 
titioners have  pursued  what  he  so  ably  pointed 
out ;  practice  has  not  changed  in  the  degree  which 
has  been  alleged ;  and  similar  means  have  gene- 
rally been  employed  to  bring  about  the  same  ef- 
fects in  every  age,  subject,  indeed,  to  such  modi- 
fications as  the  ever-varying  circumstances  must 
have  suggested  to  the  minds  of  enlightened  ob- 
servers. 

In  addition  to  all  the  foregoing  objections,  the 
utility  of  medicine  has  been  questioned  by  some, 
even  supposing  all  the  difficulties  hitherto  stated 
to  be  overcome,  on  the  ground  that  the  exercise 
of  the  healing  art  would  require  so  much  sagacity 
and  so  many  qualifications,  that  few  men  could  be 
found  equal  to  the  arduous  task  of  undertaking  it; 
and  therefore  that  it  should  be  looked  upon  as  a 
dangerous  weapon,  placed  in  the  hands  of  igno- 
rance and  quackery. 

But  in  answer  to  all  this,  it  may  be  confidently 
alleged,  that  although  disease  and  death  are  the 
necessary  consequences  of  the  laws  of  the  animal 
economy — although  man  from  his  very  constitu- 
tion, is  more  exposed  to  causes  of  disease  than 
other  animals,  even  if  civil  institutions  and  social 


Introductory  Lecture.  267 

habits  did  not  expose  him  to  a  much  greater  num- 
ber of  noxious  impressions  ; — yet  still  the  desire 
of  prolonging  life  and  of  avoiding  pain,  is  altogether 
as  natural  as  to  suffer  and  to  die.  Nature  teaches 
us  to  change  an  uneasy  posture,  to  direct  the  at- 
tention to  painful  parts,  and  to  sooth  uneasy  feel- 
ings by  the  application  of  gentle  heat  and  moisture ; 
she  also  points  out  the  necessity  of  repose  and 
removal  from  noise,  as  well  as  every  other  source 
of  irritation,  as  soon  as  our  organs  of  sense  experi- 
ence the  derangement  induced  by  fever.  Singular 
appetites,  or  craving  of  remarkable  articles  of  food 
or  drink,  which  cannot  be  accounted  for,  often 
suggest  the  means  requisite  for  recovery.  In  short, 
as  all  our  wants  are  changed  into  sufferings  when 
they  are  not  supplied  ;  and,  as  Nature  makes  a 
declaration  of  this  sort  in  the  clearest  manner,  so 
we  may  give  the  name  of  remedy  to  every  thing 
that  satisfies  a  want,  and  call  instinct,  or  the  cause 
of  those  spontaneous  actions,  the  first  of  physicians. 
Here  then,  we  behold  the  foundation  of  our  art, 
laid  by  the  hand  of  Nature  herself;  and  laid  so 
deeply  and  firmly,  that  no  efforts  we  can  make, 
are  sufficient  to  subvert  or  destroy  it.  If  it  were 
possible  therefore  to  set  medicine  aside,  as  a  sci- 
ence and  an  art,  it  would  still  be  impossible  to 
suppress  the  instinctive  feelings  of  mankind,  and, 
of  consequence,  a  much  greater  number  of  victims 
would  be  sacrificed  to  the  pretensions  of  ignorance 
and  audacity. 


INTRODUCTORY  LECTURE, 


UPON 


MEDICAL  EDUCATION. 


INTRODUCTORY  LECTURE, 

&c.  &c. 


A  HE  science  of  Medicine,  in  the  extent  which 
it  now  possesses,  exhibits  such  a  vast  expanse  of 
knowledge,  and  is  made  up  of  such  a  number  of 
other  sciences,  collateral  or  subordinate,  that  the 
best  mode  of  conducting  medical  studies,  espe- 
cially with  regard  to  their  order,  succession  and 
duration,  presents  an  inquiry  of  equal  importance 
and  difficulty.  As  different  opinions  on  this  sub- 
ject have  been  held  by  very  able  men,  I  shall  only 
attempt  to  offer  a  rapid  sketch  of  some  parts  of  it, 
which  seem  to  be  entitled  to  particular  attention. 
And  it  will  be  recollected  that  this  sketch,  being 
entirely  abstract  and  speculative,  is  only  designed 
to  exhibit  the  relations  and  dependence  of  the  dif- 
ferent branches  of  medical  science  on  one  another. 


272  Introductory  Lecture. 

It  is  generally  agreed,  that  a  system  of  instruc- 
tion in  medical  seminaries  ought  to  embrace  five 
principal  subjects. 

1.  The  knowledge  of  the  animal  economy* 
This  is  acquired  by  the  study  of  Anatomy,  Che- 
mistry and  Physiology,  or  the  science  of  man  in 
the  state  of  health. 

2.  The  knowledge  of  the  various  substances, 
both  simple  and  compound,  which  act  on  the  ani- 
mal economy.  These  necessarily  belong  to  one 
of  the  three  kingdoms  of  nature.  Their  history, 
qualities  and  uses  are  learned  by  the  study  of  the 
Materia  Medica,  Chemistry  and  Pharmacy. 

3.  The  knowledge  of  the  rules  and  means  most 
conducive  to  the  preservation  of  the  body  in  a 
state  of  health.  For  this  purpose,  as  the  subject 
is  of  great  extent,  the  study  of  Natural  Philosophy, 
Chemistry  and  Physiology  becomes  necessary. 

4.  The  knowledge  of  the  various  diseases  in- 
cidental to  the  human  body,  their  nature,  causes, 
symptoms  and  the  remedies  best  adapted  to  cure 
them.  This  is  learned  by  the  study  of  Pathology, 
or  the  science  of  man  in  a  state  of  disease,  and  by 
that  of  Therapeutics,  and  Clinical  Medicine  and 
Surgery. 


Introductory  Lecture.  273 

5.  The  history  of  Medicine  and  Surgery,  and 
the  best  manner  of  studying  these  sciences.  By 
this,  a  complete  view  of  the  subject,  in  its  whole 
extent,  will  be  exhibited.  What  has  been  already 
done  by  our  venerable  predecessors,  and  what  re- 
mains to  be  accomplished,  will  thus  be  distinctly 
seen. 

According  to  this  system  of  medical  education, 
the  various  subjects  of  instruction  which  compose 
it,  when  arranged  in  an  elementary  order,  will 
stand  as  follows : 

1.  The  plan  of  studying  medicine. — 2.  Gene- 
ral and  experimental  Natural  Philosophy,  so  far 
only  as  it  is  connected  with  medicine. — 3.  Che- 
mistry.— 4.  Anatomy. — 5.  Physiology. — 6.  Ma- 
teria Medica — under  which  it  is  proper  to  com- 
prehend every  thing  useful  in  the  healing  art, 
which  Zoology,  Botany  and  Mineralogy  afford. — 
7.  Pharmacy. — 8.  The  art  of  Prescribing. — 9. 
The  general  means  of  preserving  health,  or  what 
is  commonly  called  Hygiene. — 10.  Pathology. — 
11.  Therapeutics. — 12.  The  Practice  of  Physic 
and  Surgery. — 13.  Clinical  Medicine  and  Surge- 
ry. — 14.  The  History  of  Medicine  and  Surgery. 

Under  another  point  of  view,  these  different 
branches  of  medical  instruction  may  be  divided 
into  Theoretical 'and  Practical. 

2  M 


274  Introductory  Lecture. 

The  theory  of  medicine  consists  of  preliminary 
or  introductory  sciences,  and  those  which  are  es- 
sential, or  immediately  necessary  and  indispensa- 
ble in  the  prosecution  of  medical  inquiries. 

The  former,  that  is,  the  preliminary,  compre- 
hend Anatomy,  Chemistry,  Physiology,  Pharmacy 
and  Materia  Medica. 

The  object  of  the  latter,  is  to  apply  these  pre- 
liminary sciences,  to  accomplish  the  preservation 
of  health  and  the  cure  of  diseases.  These  direct 
or  essential  theoretical  sciences,  are  Hygiene  or 
the  general  means  of  preserving  health,  Pathology, 
and  Therapeutics. 

The  practical  department  of  medicine  consists 
in  distinguishing  and  treating  diseases,  as  they  oc- 
cur in  particular  persons. 

Since  it  is  necessary  to  commit  to  a  limited 
number  of  persons,  the  charge  of  teaching  all 
these  different  branches  of  medicine — while  at  the 
same  time  it  is  neither  possible  nor  expedient 
to  create  as  many  professors  in  a  medical  semi- 
nary, as  there  are  divisions  in  the  arrangement 
which  has  been  stated — it  becomes  proper  to  as- 
sign several  departments  to  single  professors. 
This  has  always  been  done  at  Leyden,  at  Edin- 
burgh, and  at  Gottingen,  as  well  as  at  all  other 


Introductory  Lecture.  275 

celebrated  schools  of  Physic.  Boerhaave  taught 
five  of  the  most  important  branches  of  Medicine, 
viz.  Chemistry,  Physiology,  Botany,  and  the  In- 
stitutions and  Practice  of  Medicine. 

If  an  individual  possessed  such  extraordinary 
powers  of  mind,  and  such  a  share  of  health,  acti- 
vity and  leisure,  as  to  be  competent  to  teach  all 
the  various '  departments  of  Medicine,  students 
would  derive  the  most  important  advantages  from 
his  labours  ;  because  every  part  of  the  whole  sys- 
tem would  be  consistent  with  itself.  In  propor- 
tion as  professors  are  multiplied,  some  inconve- 
niences may  be  apprehended  from  collisions  of 
opinion  as  well  as  from  disparity  of  talents. 

After  mature  deliberation  on  the  relations  sub- 
sisting between  the  various  branches  of  medical 
science,  the  following  considerations  render  it 
proper  to  unite  several  departments  of  instruction. 

1.  Anatomy  may  be  separated  from  physiolo- 
gy ;  but  physiology  cannot  so  properly  be  taught 
by  itself;  it  is  most  conveniently  conjoined  with 
the  study  of  the  human  body ;  otherwise  every 
physiological  system  will  be  defective  and  errone- 
ous. When  the  anatomy  of  the  human  body  is 
considered  separately  from  that  of  other  animals, 
many  important  views,  necessary  references,  in- 
teresting illustrations,  and  useful  conclusions,  are 


276  Introductory  Lecture. 

lost.  There  is  no  doubt  that  comparative  anato- 
my has  thrown  more  light  upon  physiology  than 
all  the  knowledge  of  the  animal  economy  derived 
from  other  sources.  Many  of  the  animal  functions 
are  even  totally  inexplicable  without  its  assistance. 
The  charge  of  teaching  Zoology,  wherever  it  be- 
comes a  part  of  medical  studies,  ought  therefore 
to  be  intrusted  to  the  professor  of  Anatomy  and 
Physiology. 

2.  Mineralogy  cannot  be  satisfactorily  under- 
stood by  confining  our  attention  to  the  external 
appearances  of  the  various  minerals  :  the  changes 
which  they  undergo  by  the  operations  of  chemistry 
must  therefore  be  detailed  in  order  to  throw  addi- 
tional light  on  the  subject.  It  is  easy  for  the 
chemist  to  teach  Pharmacy  j  and  the  art  of  pre- 
scribing is  intimately  connected  with  the  funda- 
mental principles  of  the  science  of  Pharmacy.  All 
these  several  departments  of  instruction  may  there- 
fore be  properly  committed  to  the  same  person. 

3.  The  professor  of  Materia  Medica  must  ne- 
cessarily be  well  acquainted  with  Natural  History. 
The  study  of  the  three  kingdoms  of  nature  is  un- 
avoidably undertaken  by  him,  and  therefore  be- 
comes familiar  to  his  mind.  These  inquiries, 
which  are  so  essential  to  the  prosecution  of  his 
main  subject,  prepare  him  to  give  lectures  on 
Zoology,  Mineralogy  and  Botany.     But  as  the 


Introductory  Lecture.  277 

two  former  of  these  departments,  for  cogent  rea- 
sons, are  assigned  to  the  professors  of  Anatomy 
and  Chemistry,  it  will  not  be  considered  improper, 
that  the  professor  of  Materia  Medica  should  also 
teach  Botany. 

In  order  to  preserve  regularity  in  this  system 
of  instruction,  and  to  maintain  a  proper  separation 
between  the  several  departments  of  teaching,  it  is 
advisable  for  the  professor  of  Materia  Medica,  af- 
ter having  exhibited  a  complete  history  of  the  va- 
rious medicines,  and  after  having  shewn  specimens 
of  each,  to  content  himself,  both  in  his  lectures  on 
Materia  Medica,  on  Botany  and  on  Pharmacy, 
with  enumerating  the  qualities  and  doses  of  me- 
dicinal substances  ; — and  that  he  should  refer  to 
the  teacher  of  Therapeutics,  and  the  Practice  of 
Physic,  the  charge  of  explaining  the  principles 
which  regulate  their  use,  their  modus  operandi, 
and  the  detail  of  the  particular  cases  in  which  they 
should  be  employed. — Without  this  restriction, 
Materia  Medica,  Botany  and  Pharmacy,  could  not 
be  classed  among  the  preliminary  sciences ;  and 
a  confusion  in  the  duties  of  the  professorships 
would  thence  ensue. 

4.  No  physician  ought  to  be  presumed  to  be 
unacquainted  with  Mechanical  Philosophy ;  it 
ought  always  to  serve  as  a  guide  in  the  study  of 
the  preliminary  sciences.     For  this  reason,  all  the 


278  Introductory  Lecture. 

medical  professors  ought  to  be  prepared  to  teach 
it.  But  no  professor  is  so  particularly  required  to 
understand  that  science  with  critical  exactness  as 
the  person  to  whom  the  subject  of  Hygiene  is 
committed.  It  is  the  duty  of  this  professor  al- 
ways to  hold  himself  in  readiness  to  give  a  course 
of  instruction  on  any  part  of  mechanical  philoso- 
phy which  it  may  be  necessary  to  bring  in  aid  of 
the  doctrines  delivered  in  his  own  department. 
And  therefore  his  attention  cannot  be  too  often 
directed  to  this  science. 

5.  Pathology,  Nosology  and  Therapeutics  ought 
not  to  be  taught  separately  from  each  other.  For 
it  certainly  is  the  duty  of  the  same  professor  to 
consider  man  in  a  state  of  disease  ;  to  exhibit  the 
symptoms  of  the  complaints  whose  causes  he  shall 
have  previously  explained ;  to  ascertain,  from  the 
history  of  the  symptoms,  the  nature  of  the  disease, 
its  stages  or  periods  and  the  prognosis  ;  and  to 
point  out  on  what  principles  the  treatment  ought 
to  be  conducted. 

Semeiology,  one  of  the  sub-divisions  of  Patho- 
logy, cannot  be  explained  by  itself,  without  occa- 
sioning numberless  repetitions  and  a  great  confu- 
sion of  ideas  ;  since  the  detail  of  the  symptoms  of 
diseases  is  included  in  Pathology  ; — and  the  same 
detail  is  the  subject  of  Nosology,  which  forms  the 


Introductory  Lecture.  279 

basis  and  order  of  the  observations  to  be  delivered 
by  the  professor  of  the  Practice  of  Physic. 

6.  The  professors  of  the  Practice  of  Physic 
should  teach  that  great  and  important  branch  of 
science  in  its  full  extent. 

7.  The  plan  for  conducting  medical  studies 
cannot  be  pointed  out  by  any  teacher  with  more 
advantage,  than  by  the  professor  of  the  History  of 
Medicine,  who  must  necessarily  have  occasion, 
every  day,  to  mark  the  succession  and  to  appre- 
ciate the  value  of  publications  intended  to  advance 
the  progress  of  medical  science. 

Proceeding  under  the  guidance  of  the  views 
which  have  been  presented,  and  after  deriving 
every  possible  aid  from  experience  and  observa- 
tion in  numerous  and  varied  trials,  a  distribution 
of  all  the  different  departments  of  physic  and  sur- 
gery, according  to  this  plan  might  be  made  among 
ten  professors. 

The  last,  in  order,  of  these  departments,  would 
be  the  History  of  Medicine  and  Surgery,  and  the 
plan  for  conducting  medical  study  and  observa- 
tion. This  subject  is  one  of  the  most  profound 
and  philosophical,  and,  at  the  same  time,  one  of 
the  most  interesting  that  can  engage  the  conside- 
ration of  students.     These  two  courses,  according 


280  Introductory  Lecture. 

to  the  preceding  sketch,  are  given  in  charge  to  one 
professor. 

The  whole  of  the  proposed  system,  shews  the 
intimate  relations  by  which  Surgery  is  connected 
with  Medicine.  It  certainly  cannot  be  denied, 
that,  in  every  just  estimation  of  the  subject,  Sur- 
gery has  always  been  regarded  as  a  part  of  Me- 
dicine ;  and  it  must  be  granted,  that,  from  the 
first  lesson  of  theory,  to  that  wherein  the  means  of 
cure  are  pointed  out,  the  education  of  physicians 
and  surgeons  has  been  conducted  on  the  same 
principles.  By  thus  restoring  surgery  and  medi- 
cine to  one  another,  the  moderns  will  follow  more 
closely  the  laws  of  nature,  from  which  they  have 
improperly  deviated  since  the  times  of  the  an- 
cients. In  the  schools  of  Cos,  Smyrna  and  Alex- 
andria, all  the  physicians  were  surgeons.  The 
treatises  of  Hippocrates  on  Surgery,  are  reckoned 
amongst  the  best  to  be  found  in  his  works.  Galen 
wrote  on  the  same  branch,  and  practised  it  with 
success.  In  the  time  of  Celsus,  medicine  was 
divided  into  three  parts,  the  first  of  which  com- 
prehended the  treatment  of  internal  diseases  ;  the 
second  that  of  external  ones  ;  and  the  third  part 
respected  dietetics,  the  knowledge  of  which  is 
quite  as  necessary  to  surgeons  as  to  physicians. 
In  the  time  of  iEtius,  the  physicians  still  practised 
surgery.  And  this  fortunate  union  of  the  two  sci- 
ences, which  should  never  have  been  interrupted. 


Introductory  Lecture,  281 

ceased  on  the  decline  of  the  schools  of  the  empire 
in  the  time  of  Justinian. 

Although  many  faults  may  doubtless  be  dis- 
covered in  several  parts  of  this  plan  of  medical 
education,  it  must  be  conceded  that  it  presents  a 
consistent  and  regular  system.  While,  we  admit 
that  it  is  too  complicated,  too  unwieldy  and  too 
expensive  for  this  country,  in  its  present  state,  we 
cannot  forbear  hoping  that  the  time  will  arrive 
when  we  shall  be  able  to  make  a  nearer  approxi- 
mation  to  it. — A  course  of  lectures  on  the  histor)*- 
of  Medicine,  and  on  the  plans  for  conducting  me- 
dical study  and  observation,  though  these  subjects 
do  not  certainly  rank  among  those  which  are  of 
primary  and  fundamental  importance  to  the  stu- 
dent, ought  undoubtedly  to  be  reckoned  among 
such  as  are  the  most  arduous,  the  most  learned, 
and  the  most  useful  in  the  whole  system. 

Systems  of  education  in  America,  notwithstand- 
ing the  improvements  they  have  undergone  with- 
in a  few  years  past,  are  still  extremely  defective. 
At  present,  we  are  necessarily  restricted  to  the 
consideration  of  the  more  prominent  defects  which 
may  be  observed  in  the  plans  of  medical  educa- 
tion. And  here,  our  time  will  only  allow  me  to 
remark,  that,  in  general,  public  opinion  and  the 
prevalent  usages  of  this  country,  permit  the  busi- 
ness of  medical  instruction  to  occupy  so  short  a 


282  Introductory  Lecture. 

period,  and  to  be  hurried  over  with  so  much  pre- 
cipitation, that  it  is  necessarily  very  imperfect, 
and  the  attainments  of  the  student  very  superfi- 
cial. This  defect  must  be  unavoidably  experi- 
enced at  every  stage  of  his  subsequent  course. 
As  example  on  this  subject  will  probably  be 
much  more  impressive  than  opinion,  I  shall  brief- 
ly exhibit  an  account  of  the  objects  of  study,  and 
the  periods  of  time,  severally  assigned  for  a  course 
of  medical  instruction  by  some  eminent  physicians 
in  Germany,  Great  Britain  and  France. 

During  the  late  agitation  of  the  subject  of  me- 
dical reform  in  Great  Britain,  much  attention  has 
been  bestowed  on  the  several  points  of  medical 
education.  In  a  late  publication,  one  of  the  most 
distinguished  physicians*  in  England  has  present- 
ed a  delineation  of  a  course  of  study,  from  which 
he  endeavours  to  make  it  appear  that  a  young  man 
may  employ  five  or  six  years  at  medical  semina- 
ries with  advantages  of  the  most  essential  kind, 
which  he  must  entirely  forfeit  by  setting  out 
sooner  as  an  independent  practitioner,  and  which 
students  of  three  years,  as  such,  can  therefore 
never  possess. 

The  following  is  a  sketch  of  the  plan  of  study 
which  he  proposes. 

*  Dr.  Beddocs. 


Introductory  Lecture.  283 

1st  year.  Dissection,  anatomical  lectures,  read- 
ing on  that  subject,  drawing,  and  comparison  of 
anatomical  engravings  with  the  objects  in  nature. 
For  the  purpose  of  relaxation,  as  well  as  instruc- 
tion, a  course  of  chemistry,  and  reading  of  element- 
ary books  on  that  science.  These  studies  occupy 
the  winter.  In  spring  and  summer,  a  course  of 
comparative  anatomy,  dissection  of  animals,  study 
of  botany  and  physiology. 

2d  year.  Anatomy  exactly  as  before  ; — at- 
tendance on  clinical  lectures  in  surgery  :  if  none 
of  these  should  be  given,  let  there  be  close  study 
of  surgical  cases,  particularly  of  surgical  accidents 
at  first ; — let  morbid  anatomy  be  practically  cul- 
tivated at  every  opportunity.  In  spring,  summer 
and  autumn,  let  attention  be  given  to  practical 
chemistry,  pharmacy,  botany  and  materia  medica. 

3d  year.  In  winter,  anatomy  and  surgery  to 
be  still  continued ;  but  external  diseases  now  more 
than  accidents.  During  spring,  summer  and  au- 
tumn of  this  year,  let  obstetrics,  medical  jurispru- 
dence, comparative  anatomy  and  physiology,  be 
the  principal  objects  of  attention,  and  some  of  the 
other  before- mentioned  pursuits  may  also  be  oc- 
casionally resumed. 

4th  year.  Anatomy  to  be  pursued  with  unaba- 
ted diligence — lectures  on  the  practice  of  physic — 


284  Introductory  Lecture. 

clinical   lectures — observation   of  medical  cases 
and  reading  of  practical  books. 

5th  and  6th  years.  Close  attendance  on  hos- 
pitals, with  a  course  of  practical  reading  and  lec- 
tures, at  Paris  or  London,  if  these  places  be  ac- 
cessible. During  the  summer  and  autumn  of  one 
of  these  years,  let  some  time  be  employed,  if  pos- 
sible, in  attending  military  hospitals,  especially  in 
the  field.  During  the  rest  of  these  years,  let 
some  attention  be  given  to  oral  instruction,  as  it 
may  best  offer,  in  other  branches  of  natural  history 
besides  botany,  in  natural  philosophy  and  in  some 
of  the  more  useful  of  the  speculative  sciences. 
From  one  or  other  of  these,  the  acquisition  of  as 
many  facts  as  possible  concerning  the  mental  ope- 
rations, should  be  considered  as  an  essential  part 
of  the  stock  of  knowledge  necessary  to  the  phy- 
sician. 

The  Faculty  of  medicine  of  Vienna,  the  esta- 
blishment of  which  is  recent,  since  it  was  the  work 
of  Van  Swieten,  prescribes  to  the  pupils  five  years 
of  study.  The  Jirst  year,  they  are  directed  to 
study  Anatomy,  Botany  and  Chemistry — in  the 
second  Physiology  is  added  to  these — during  the 
third  year  they  continue  the  study  of  Physiology, 
and  that  of  Pathology  and  Materia  Medica  is  add- 
ed— during  the  fourth  year,  they  join  to  the  two 
last  mentioned  branches,  the  study  of  the  Practice 


Introductory  Lecture.  285 

of  Physic — and  in  the  course  of  the  fifth  year, 
while  they  continue  to  pay  the  utmost  attention  to 
the  Practice  of  Physic,  they  are  directed  to  reca- 
pitulate all  their  former  studies. 

Monsieur  Tissot,  who  has  written  very  well  on 
this  subject,  advises  four  years  of  study.  He 
prescribes  for  the  first  year,  the  same  course  as 
Van  Swieten — for  the  second,  he  recommends  the 
course  allotted  by  Van  Swieten  for  the  third,  with 
the  addition  of  Surgery,  which  is  omitted  in  the 
distribution  of  the  plan  formed  by  Van  Swieten. 
For  the  third  year,  he  advises  the  study  of  the 
history  of  Medicine,  of  Prophylaxis,  of  medical 
Jurisprudence  and  of  Clinical  Medicine  ;  on  which 
latter,  the  students  ought  to  be  required  to  spend 
exclusively  the  fourth  year. 

About  eighteen  years  ago,  a  learned  and  res- 
pectable society  of  physicians  at  Paris,  after  much 
deliberation  on  the  subject,  communicated  their 
opinion  to  the  public,  that  the  duration  of  medical 
studies  ought  not  to  be  less  than  six  years — and 
for  this  space  of  time,  they  direct  the  following- 
course  of  study. 

1st  year.  Natural  Philosophy,  so  far  as  it  is 
connected  with  Medicine,  Anatomy  and  Phvsio- 
logy.     Within  this  period,  the  students   should 


286  Introductory  Lecture. 

begin  to  learn  the  art  of  dissection,  and  devote 
themselves  to  it. 

2d  year.  Continuation  of  the  preceding  stu- 
dies, Dissection,  Chemistry  and  Mineralogy, 
Zoology  and  Botany, 

3d  year.  Continuation  of  Anatomy,  Chemistry 
and  Botany,  to  which  are  added  Materia  Medica, 
Pharmacy  and  the  Prophylaxis  or  Preventive 
Medicine. 

About  the  middle  of  this  third  year,  the  stu- 
dents begin  to  attend  the  wards  appropriated  to 
practical  or  clinical  instruction.  They  attend  a 
course  of  lectures  on  the  operations  of  Surgery,  of 
which  they  study  the  elements. 

4th  year.  Continuation  of  Materia  Medica, 
Pharmacy  and  Prophylaxis,  and  the  Institutions 
of  Medicine,  that  is,  Pathology,  Nosology  and 
Therapeutics.  All  this  period,  the  students  learn 
the  art  of  applying  bandages,  and  practise  the  ope- 
rations of  surgery  on  the  dead  body.  They  like- 
wise begin  the  study  of  Obstetrics,  and  give  a 
large  portion  of  time  to  the  lectures  on  Clinical 
Medicine. 

5th  and  6th  years.  These  are  dedicated  to  the 
study  of  Clinical  Medicine  and  Surgery.    Medical 


Introductory  Lecture.  287 

Jurisprudence  and  the  History  of  Medicine  also 
claim  some  portion  of  time  during  these  two 
years. 

From  a  consideration  of  the  courses  of  instruc- 
tion which  have  been  now  presented,  it  will  be 
easy  to  perceive  the  importance  of  laying  the  foun- 
dation of  medical  education  in  the  most  exact  ac- 
quaintance with  the  mechanical  and  vital  parts  of 
the  human  frame.  The  knowledge,  indeed,  of 
the  human  structure  should  be  ultimately  render- 
ed so  ready  and  distinct,  that  as  soon  as  a  part  of 
the  body  is  named,  there  should  instantly  arise  a 
clear  image  of  its  situation,  dependencies  and  of- 
fice, so  far  as  the  latter  is  understood. — To  this 
should  be  superadded  the  anatomy  of  disease.  By 
this  course,  what  may  be  called  the  grammar  of 
universal  medicine,  will  be  placed  in  the  hands  of 
the  student,  and  eventually  treasured  up  in  his 
memory.  The  pupils  of  most  schools,  for  want 
of  being  thoroughly  grounded  in  these  principles, 
are  turned  loose  upon  the  sick,  not  only  with 
scanty  and  confused  notions,  but  with  very  inad- 
equate power  of  acquiring  others.  Had  a  severe 
practical  study  of  the  ordinary  structure  been  ge- 
nerally followed  up  for  the  last  fifty  years  by  an 
investigation  of  every  gradation  of  change,  indu- 
ced by  disease,  we  should,  by  this  time,  have  had 
infinitely  less  uncertainty  in  the  doctrines  and 
principles  of  medicine. 


288  Introductory  Lecture. 

By  the  application  of  genius  and  industry  to  the 
art  of  healing,  much  has  been  already  done,  and 
much  more  may  be  expected  to  be  hereafter  at- 
chieved.  The  ancient  fabrics  of  physic  have  un- 
dergone a  close  examination — a  great  proportion 
of  them  has  been  condemned  and  demolished — 
much  rubbish  has  been  cleared  away — that  part 
of  the  pile  alone  which  rests  on  the  rock  of  truth 
and  enlightened  experience,  has  withstood  the 
force  of  every  assailant  and  defied  the  ravages  of 
time. 

The  true  end  of  science  is  the  production  of 
new  powers,  and  the  application  of  them  to  the 
greatest  possible  variety  of  useful  purposes.  The 
votaries  of  Medicine  then  should  never  be  idle, 
nor  weary  in  the  pursuit  of  discovery  and  im- 
provement ;  for  industry  or  accident  may  event- 
ually teach  them  to  subdue  maladies  which  now 
elude  every  exertion  of  art.  There  was  a  period 
when  ague  and  syphilis  were  considered  as  incu- 
rable :  the  antidote  to  both  is  now  well  known. 
It  is  not'  presumptuous  to  believe  that  Nature,  in 
the  fulness  of  her  beneficence,  holds  a  remedy  for 
every  evil  by  which  we  are  assailed.  The  period 
we  trust  is  not  remote  when  the  means  of  arrest- 
ing the  ravages  of  pestilence  and  consumption  will 
be  placed  among  the  trophies  of  medical  discovery. 


AN 

INQUIRY 


CONCERNING 


CUTANEOUS  PERSPIRATION, 


THE   OPERATION  AND  USES 


SUDORIFIC  REMEDIES 


2  o 


TO 

WILLIAM  HEBERDEN,  M.  D,  fee. 

LONDON. 

Sir, 

IN  inscribing  to  You  the  following  Essay, 
on  an  important  subject  of  medical  inquiry,  it  is 
not  my  intention  to  refer  to  the  opinions  which  it 
contains,  of  which  I  am  not  a  competent  judge  ; 
but,  as  the  representative  of  its  Author,  to  express 
my  profound  respect. 

It  was  one  of  the  honours  of  his  life  to  enjoy 
your  correspondence  ;  and  it  was  an  honour  which 
he  by  no  means  failed  to  appreciate.  Though  a 
warm  friend  to  his  native  Country,  and  an  ardent 
admirer  of  its  character,  institutions  and  attain- 
ments, he  looked  with  veneration  on  the  literature 
and  science  of  Europe,  and  was  especially  ambi- 
tious of  maintaining  an  intercourse  with  some  of 
the  great  Masters  of  Medicine  in  the  land  of  his 
Fathers. 

The  following  Essay,  as  well  as  the  most  of 
those  which  compose  the  present  volume,  and 
which  were  laid  before  the  public  in  the  pages  of 


[     292     ] 

the  Medical  Repository,  were  considered  by  then 
Author  as  fugitive  pieces,  which  his  native  mo- 
desty, as  well  as  the  high  standard  of  literary  and 
scientific  merit  which  he  was  accustomed  to  re- 
cognise, prevented  him  from  collecting,  and  re- 
publishing himself.  Had  his  life  been  spared,  he 
4*ould  probably  have  executed  other  purposes, 
more  useful,  as  well  as  more  honourable  to  his 
memory.  As  it  is,  accept  of  the  best  offering 
which  it  is  in  the  power  of  fraternal  partiality  to 
present. 

I  have  the  honour  to  be,  Sir, 

with  the  highest  consideration, 
your  obedient  servant, 

THE  EDITOR 
Princeton,  N.  }.\ 
March  2d,  1814.  S 


AN  INQUIRY,  &c. 


J_T  is  not  intended,  at  present,  to  devote  much 
attention  to  a  physiological  view  of  the  cutaneous 
perspiration.  This  would  lead  to  a  great  length 
of  detail  on  many  points  sufficiently  discussed  in 
common  books,  and  is  not  necessarily  connected 
with  that  particular  survey  of  the  subject  now  to 
be  taken.  Under  the  term  perspiration  will  be 
included  all  the  varieties  of  the  cutaneous  dis- 
charge, as  well  the  subtile  vapour  called  insensi- 
ble, or  aeriform  perspiration,  as  the  same  matter 
condensed  on  the  skin  into  visible  drops,  and 
called  sweat ;  because  both  are  supposed  to  issue 
from  the  same  sources,  and  are  only  to  be  distin  - 
guished,  as  to  component  materials,  by  the  latter 
being  mixed  with  the  sebaceous  matter  of  the, 


294     Remarks  on  Cutaneous  Perspiration. 

skin.  The  labours  of  Sanctorius,  and  others,  to 
ascertain  the  quantity  of  fluid  exhaled  by  this  out. 
let,  are  proofs  of  uncommon  diligence  and  perse- 
verance ;  but  are  rendered  uncertain  in  their  re- 
sult, and  nearly  fruitless,  by  inattention  to  the  an- 
tagonizing function  of  the  absorbents.  Enough, 
however,  has  been  discovered  to  demonstrate  that 
great  differences,  with  respect  both  to  quantity 
and  quality,  arise  from  climate,  season,  weather, 
age,  sex,  temperament,  diet,  customs,  manners, 
&x.  The  principal  uses  of  perspiration  seem  to 
be,  to  preserve  an  equilibrium  between  the  fluids 
and  solids  of  the  system,  and,  perhaps,  to  permit 
the  escape  of  certain  useless  matters — to  keep  the 
skin  moist,  soft  and  pliable,  in  order  to  maintain 
its  easy  flexibility  in  the  active  motions  of  the 
limbs  and  body,  and,  at  the  same  time,  to  pre- 
serve the  accuracy  of  the  sense  of  touch — and, 
lastly,  to  diminish  the  effects  of  increased  excite- 
ment, by  moderating  the  heat  and  excessive  ac- 
tion of  the  skin,  and  thereby  to  preserve  the  whole 
system  more  cool  and  temperate. 

There  is  scarcely  a  function  of  the  human  body, 
whose  various  conditions  are  so  often  mentioned 
as  the  cause  of  disease,  and  the  means  of  recovery, 
as  the  cutaneous  perspiration.  Physicians,  and, 
in  imitation  of  them,  most  others,  ascribe  to  the 
vicissitudes  of  this  discharge  a  long  train  of  mor- 
bid and  fatal  consequences ;  and,  upon  the  resto 


Remarks  on  Cutaneous  Perspiration.     295 

ration  or  increase  of  it,  they  every  day  erect  most 
important  indications  of  cure.  Much  is  said  of 
the  mischief  of  a  suppression  of  perspiration ;  of 
the  retention  of  morbific  matter ;  of  plethoric  ac- 
cumulation arising  from  a  stoppage  of  the  pores 
of  the  skin,  producing  congestion  and  inflamma- 
tion in  different  viscera ;  of  the  good  or  bad  ef- 
fects of  a  moist  and  relaxed,  or  of  a  dry  and  rigid 
skin ;  of  the  benefits  of  determining  to  the  surface 
of  the  body  ;  of  the  efficacy  of  sweating,  &c.  And 
it  is  well  known,  that  in  many  interesting  and  cri- 
tical states  of  fevers,  the  treatment  is  chiefly  con- 
fided to  diaphoretic  remedies.  But  many  of  these 
opinions,  however  venerable  for  their  antiquity,  or 
the  number  and  eminence  of  their  advocates,  ap- 
pear, at  best,  to  stand  on  doubtful  ground ;  or, 
rather,  must  be  pronounced  inconsistent  with  prin- 
ciples now  generally  admitted.  To  such  persons 
as  have  renounced  those  opinions,  and  embraced  a 
more  rational  and  enlightened  pathology  on  this 
subject,  some  apology  is  due  for  this  inquiry.  If 
the  writer  had  not  reason  to  conclude,  that  a  large 
majority  of  the  physicians  and  people  of  this 
country  still  adhere  to  those  opinions,  and  that  the 
practical  influence  of  them  is  now  very  extensive 
and  pernicious,  he  would  have  declined  to  impose 
the  present  remarks  on  the  reader. 

Cutaneous  perspiration  has  been  supposed  to 
bear  an  interesting  relation  to  two  important  ob 


296     Remarks  on  Cutaneous  Perspiration, 

jects — the  operation  of  cold  on  the  animal  sys- 
tem— and  the  critical  solution  of  febrile  diseases. 
By  many,  what  is  called  catching  cold,  and  obstruc- 
tion of  'perspiration,  are  often  indifferently  used  as 
phrases  of  the  same  import ;  and  it  is  commonly 
believed,  that  the  former  depends  upon  a  suppres- 
sion of  the  usual  discharge  of  the  perspirative  ves- 
sels of  the  skin,  and  may  be  relieved  by  a  restora- 
tion of  that  discharge.  It  is  also  generally  sup- 
posed, that  the  sweating  stage  of  fevers  is  critical 
to  the  hot  stage ;  and,  therefore,  that  promoting 
perspiration  is  a  leading  object  in  the  treatment  of 
such  cases. — Passing  by  other  views  that  might 
be  taken  of  this  subject,  it  will  be  the  chief  de- 
sign of  these  observations  to  oppose  those  two 
opinions,  which  are  presumed  to  be  erroneous  and 
mischievous. 

In  stating  the  doctrine  concerning  the  operation 
of  cold  on  the  human  body,  it  is  admitted  by  all 
to  be  a  most  productive  source  of  disease.  Sy- 
denham did  not  over-rate  the  noxious  effects  of  it, 
when  he  asserted  them  to  exceed  the  combined 
ravages  of  war,  famine,  and  pestilence.  It  is  also 
admitted,  that  cold,  applied  to  the  skin,  in  any 
considerable  degree  or  duration,  will  always  more 
or  less  diminish  perspiration ;  but  it  is  denied  that 
the  inflammatory  diseases  thence  resulting  are  pro- 
duced by  this  diminution. 


Remarks  on  Cutaneous  Perspiration.     297 

Great  variations  of  the  quantity  of  perspiration 
are  well  known  often  to  take  place  without  any 
morbid  consequences.     Not  to  mention  climate 
and  season,  which  may  be  said  only  gradually  to 
produce  their  changes,  the  different  states  of  the 
weather  sometimes  suddenly  lessen  this  evacua- 
tion, and  yet  no  injury  ensues.     The  urine  and 
perspiration   are  always  ready  to   accommodate 
each  other  ;  every  person  will  acknowledge  this, 
who  attends  to  the  comparative  quantities  of  these 
evacuations  in  summer  and  winter ;  and  at  any 
time  the  comparison  may  be  made,  by  giving  to 
a  person  large  draughts  of  any  aqueous  fluid,  and 
alternately  applying  cold  and  heated  air  to  his 
skin ;  as  it  will  be  found  that  the  former  deter- 
mines the  fluid  to  pass  off  by  the  kidneys,  and  the 
latter  by  the  cutaneous  pores.     And  besides  the 
effects  of  temperature,  the  quantity  of  perspiration 
must  be  materially  affected  by  different  applica- 
tions  to  the  skin.      Many  of  the  ancients,  and 
particularly  the  Greeks  and  Romans,  were  in  the 
habit  of  applying  oil  to  the  skin,   after  bathing ; 
and  the  Athletse  rubbed  a  composition  of  oil  and 
wax,  mixed  with  some  agglutinating  and  aroma- 
tic substances,  over  their  bodies,  previous  to  their 
entering  on  the  arena.     Some  nations  have  painted 
their  bodies  all  over,  as  the  Picts  of  North-Britain, 
who  are  generally  said  to  have  received  their  name 
from  this  circumstance,  though  it  was  certainly 
common  to  the  other  ancient  inhabitants  of  Bri- 

9.     T) 


298     Remarks  on  Cutaneous  Perspiration. 

tain ;  and  this  custom,  which,  in  a  greater  or  less 
degree,  is  known  to  prevail  among  the  savages  of 
all  countries,  is  still  practised  by  the  Indians  of 
this  continent,  who  anoint  their  bodies  with  bear's 
grease,  mixed  with  a  clay  which  resembles  the 
colour  of  their  skins.*  The  Hottentots  smear 
themselves  all  over  with  grease.  The  large  use 
of  powder  and  pomatum  among  ourselves  deserves 
to  be  mentioned,  though  the  application  of  them, 
being  solely  to  the  head,  cannot  be  supposed  to 
produce  much  effect.  These  several  practices 
have  been  more  or  less  in  use  for  time  immemo- 
rial ;  they  must  all  of  them  much  diminish  the 
quantity  of  perspiration ;  and  yet  no  injury  or  in- 
convenience is  alleged  to  have  resulted.  The 
conclusion,  therefore,  is  unavoidable,  that  this 
discharge  from  the  skin  may  be  suddenly  arrest- 
ed, and  remain  so  a  long  time,  without  disease. 

But  it  is  so  far  from  being  true,  that  inflamma- 
tory catarrh  consists  in  a  stoppage  of  perspiration, 
that  it  is  commonly  attended  with  an  augmenta- 
tion of  that  discharge.  In  the  febrile  state  of  ca- 
tarrh, the  cutaneous  vessels  possess  a  fulness  and 
activity  far  beyond  their  natural  condition  :  this  is 
ascertained  by  the  greater  heat,  redness  and  tur- 
gescence  of  the  skin.  Excessive  energy  of  action 
produces  correspondent  excitement  of  vessels, 

*  Rush's  Medical  Inquiries,  vol.  i,  p.  16. 


Remarks  on  Cutaneous  Perspiration.     299 

which  must -consist  in  excessive  oscillations,  and, 
therefore,  in  increased  force  of  the  circulation  of 
their  fluids  ;  of  consequence,  a  greater  quantity  of 
blood  is  sent  to  the  skin,  and  a  greater  quantity  of 
perspirable  matter  secreted.*  Nothing  can  plau- 
sibly oppose  the  conclusion,  but  the  doctrine  of 
spasm  of  the  extreme  vessels,  mistaken  for  the 
collapse  or  inactivity  of  those  vessels,  arising  from 
deficient  stimulus  of  heat ;  but  that  doctrine  is 
now  generally  relinquished  as  visionary,  super- 
fluous, and  improbable.  A  further  proof  that  this 
disease  does  not  arise  from  obstruction  of  the  cu- 
taneous pores,  may  be  derived  from  the  inefficacy 
of  copious  perspiration  in  the  treatment  of  it. 

The  opinion  of  the  morbid  operation  of  cold 
depending  upon  obstruction  of  perspiration,  re- 
ceived a  deadly  blow  from  Brown's  doctrine  of 
the  effect  of  stimulating  powers  applied  to  accu- 
mulated excitability  ;  upon  which  is  erected  his 
theory  of  catarrh,  and  many  other  inflammatory 
diseases  ;  and  which  explains  a  multitude  of  phe- 
nomena of  the  living  system,  otherwise  unintelli- 
gible. This  doctrine  is  founded  upon  a  general 
law  of  animal  and  vegetable  life.    It  is  exemplified 

*  Heat  of  the  skin,  in  the  common  temperature  of  the  air, 
always  denotes  an  increase  of  perspiration,  whether  visible  or 
not ;  because  the  heat  is  produced  by  the  increase  of  secre- 
tion. It  follows,  that  a  defect  of  perspiration  can  only  exist 
when  the  skin  is  cold.     Darwin's  Zoonomia,  vol.  ii,  p.  699. 


500     Remarks  on  Cutaneous  Perspiration. 

by  the  glow  of  the  skin  after  cold  bathing,  and 
the  redness  of  the  hands  after  holding  snow  or  ice ; 
by  the  dazzling  splendour  of  the  sun  in  leaving 
a  dark  room  ;  by  the  pernicious  effects  of  much 
stimulant  food  on  the  stomachs  of  famished  per- 
sons ;  by  the  gangrene  of  frozen  limbs  from  the 
sudden  application  of  too  much  heat ;  and,  lastly, 
by  a  multitude  of  similar  occurrences  in  vegetable 
life.*    When,  therefore,  any  part  of  the  body  has 
been  exposed  to  cold,  it  becomes  liable  to  be  much 
more  affected  by  heat,  or  other  stimuli,  than  be- 
fore such  exposure.     And  this  luminous  princi- 
ple, aided  by  the  direct  or  reverse  sympathy  ex- 
isting between  associated  actions  in  different  parts 
of  the  system,  will,  it  is  conceived,  be  sufficient 
to  explain  all  the  phenomena  of  catching  cold, 
without  resorting  to  the  mysterious  and  fanciful 
doctrine  of  obstructed   perspiration.     It  is  not 
merely  with  the  view  of  combating  a  speculative 
opinion,  which  might  have  been  considered  harm- 
less, and  undeserving  of  notice,  that  these  obser- 
vations are  made.    To  relieve  the  imaginary  stop- 
page of  perspiration,  after  exposure  to  cold,  peo- 
ple are  often  observed  to  betake  themselves  to  the 
use  of  warm  or  spiritous  liquors,  to  confinement 
in  close  or  hot  rooms,  and  to  a  weight  of  bed- 
clothes,  which   must   all   greatly  aggravate  the 
disease. 

*  Facts  oi  tlijs  kind  may  be  found  in  the  Botanic  Garden, 
part  ii,  p.  31. 


Remarks  on  Cutaneous  Perspiration.     301 

The  second  branch  of  the  subject  now  recurs ; 
viz.  the  relation  which  the  cutaneous  perspiration 
bears  to  the  critical  solution  of  febrile  diseases. 
It  is  an  opinion  sanctioned  by  high  antiquity,  and 
which  prevails  at  the  present  day,  that  sweating 
is  the  principal  means  employed  by  nature,  and, 
therefore,  to  be  imitated  by  art,  for  effecting  the 
critical  solution  of  fevers.  It  is  not  surprising 
that  this  doctrine  should  have  become  so  preva- 
lent, when  it  is  recollected  how  commonly  the 
coincidence  is  observed  between  sweating  and  a 
favourable  crisis.  The  opinion  of  Sydenham,  that 
fever  is  an  effort  of  nature  to  discharge  something 
noxious  from  the  system  ;  the  lentor  and  morbific 
matter  of  Boerhaave,  and  the  spasm  of  Hoffman 
and  Cullen,  have  all  had  a  share  in  attaching  un* 
due  importance  to  cutaneous  perspiration,  and  in 
supporting  the  critical  subserviency  of  sweating 
to  the  hot  stage  of  fevers.  The  mere  coincidence, 
however,  of  sweating  and  crisis,  cannot  be  deem- 
ed sufficient  to  establish  the  relation  of  cause  and 
effect.  And  the  doctrines  of  the  celebrated  au- 
thors just  mentioned  are  too  hypothetical,  and  too 
irreconcilable  with  numerous  facts  and  phenomena 
to  admit  of  defence  in  the  present  state  of  medical 
science.  It  is  to  be  lamented,  indeed,  that  many 
who  are  emancipated  from  the  hypotheses  of  those 
authors,  are  still  enslaved  by  their  language  and 
practice.      Error  does  not  always  give  way  tq» 


302     Remarks  on  Cutaneous  Perspiration. 

truth,  when  the  foundation  on  which  it  rose  is 
known  to  be  dissolved. 

It  will  not  be  difficult  to  maintain,  that  during 
the  hot  stage  of  fever,  no  stoppage  of  perspiration 
takes  place — and  that,  even  if  such  stoppage  were 
admitted  to  exist,  the  matter  of  perspiration  con- 
tains  nothing  whose  retention,  during  that  stage, 
can  be  supposed  hurtful  to  the  system,  or  whose 
elimination  can  hasten  the  critical  solution. 

An  eminent  pathologist*  has  placed  the  former 
of  these  positions  in  a  clear  point  of  light.  He 
asserts,  that  the  matter  of  perspiration  is  secreted 
in  as  great,  or  perhaps  a  greater,  quantity  during 
the  hot  fit  of  fever,  than  towards  the  end  of  it, 
when  the  sweat  is  seen  upon  the  skin.  He  as- 
cribes the  dryness  of  the  skin,  in  the  hot  fit,  to 
the  more  energetic  action  of  the  cutaneous  ab- 
sorbents,! which  re-absorb  part  of  what  is  se- 
creted, and  to  the  greater  heat  of  the  skin  evapo- 
rating the  remainder.  He  refers  the  appearance 
of  sweat,  at  the  decline  of  the  fever  fit,  to  the  con- 
tinued  energy  of  the  secreting  vessels,  actuated  by 

f  Dr.  Darwin's  Zoonomia,  vol.  ii,  p.  19  &  20. 

f  I  am  aware  that  the  absorbent  power  of  the  skin,  except 
when  assisted  by  friction,  is  questioned  by  M.  Seguin,  and 
other  respectable  physiologists  ;  but  the  facts  in  support  of  it 
are  so  numerous  and  decisive,  that  mv  doubts  are  all  removed. 


Remarks  on  Cutaneous  Perspiration.     303 

all  the  heat  of  the  interior  parts  of  the  system,  and 
of  the  circulating  blood ;  while  the  mouths  of  the 
absorbents,  cooled  by  the  external  air  and  bed- 
clothes, much  sooner  lose  their  increased  action. 
And  thus,  after  an  able  discussion  of  the  subject, 
he  concludes  that  sweats  are  not  critical  to  the  hot 
fit  any  more  than  the  hot  fit  is  critical  to  the  cold 
fit ;  that  they  are  merely  the  natural  consequence 
of  the  decline  of  the  hot  fit,  flowing  from  the  di- 
minished action  of  the  absorbents,  and  the  dimi- 
nished evaporation  from  the  skin  ;  and  that  pro- 
fuse sweats,  at  the  decline  of  fevers,  occur  more 
frequently  than  copious  urine  or  diarrhoea,  be- 
cause the  cutaneous  absorbents,  exposed  to  the 
access  of  the  external  cool  air,  sooner  abate  of 
their  increased  action  than  the  urinary  or  intestinal 
absorbents.  The  clear  and  decisive  reasoning  by 
which  these  opinions  are  defended,  will  be  seen  at 
large  in  the  work  referred  to  above.  The  doc- 
trine, therefore,  that  the  material  cause  of  fevers  is 
retained  and  shut  up,  during  the  hot  stage,  by  the 
heat  and  dryness  of  the  skin,  will,  at  least,  be  con- 
sidered as  improbable. 

But  if  it  were  even  admitted,  that  the  perspi- 
rable matter  is  confined  within  the  system  durine 
the  hot  stage  of  fever,  it  cannot  be  legitimately 
inferred,  that  such  retention  becomes  noxious,  or 
that  the  elimination  of  it  would  produce  the  critical 
solution.     This  matter  does  not  appear  to  be  ex« 


304     Remarks  on  Cutaneous  Perspiration. 

crementitious ;  if  that  epithet  be  used  to  signify 
matter  acrid,  corrupted,  or  hurtful,  in  case  of  be- 
ing retained  in  the  body.     On  the  contrary,  it  is 
bland,  inodorous,  and  insipid,  in  its  natural  state. 
And,  considering  how  incessantly  and  plentifully 
it  is  emitted  from  the  whole  surface  of  the  body, 
it  will  readily  be  seen  how  inconvenient  and  dis- 
gustful the  society  and  near  approximation  of  the 
bodies  of  men  would  have  become,  if  nature  had 
not  exempted  it  from  the  foetor  and  other  excre- 
mentitious  qualities  of  the  urine  and  fasces.     The 
diminution  of  it  by  oiling  the  skin,  and  the  sup- 
pression of  it  by  painting,  &c.  prove  that  its  con- 
stant and  equable  discharge  is  not  necessary  to  life 
or  health.     There  can  be  no  doubt  that  its  prin- 
cipal uses  are  to  preserve  the  softness  and  pliancy 
of  the  skin,  and  the  accuracy  of  the  sense  of 
touch  ;  uses  implying  qualities  very  remote  from 
excrementitious.      A  great   proportion  of  it  is 
known  to  be  habitually   absorbed  in  the  moment 
of  excretion,   without   inconvenience  or  injury ; 
and  no  material  difference  has  yet  been  proved  to 
exist  between  this  matter  of  perspiration  and  the 
moisture  which  bedews  and  lubricates  all  the  in- 
ternal membranes  of  the  body,  and  which  is  al- 
ways entirely  absorbed  in  a  state  of  health.     It  is, 
indeed,  true,  that  the  perspirable  matter  of  the 
lungs,  apparently  the  same  as  that  emanating  from 
the  skin,  and  also  that  of  the  axilla?  and  feet, 
sometimes  emit  a  disagreeable  odour.     But  this 


Remarks  on  Cutaneous  Perspiration.     305 

depends  so  much  upon  constitutional  and  morbid 
peculiarities,  or  upon  want  of  cleanliness,  that  it 
can  furnish  no  sufficient  ground  to  establish  prin- 
ciples different  from  such  as  are  here  contended  for. 

If  the  matter  of  perspiration,  whether  aeriform 
or  aqueous,  be  subjected  to  chemical  analysis,  it 
will  be  found  to  contain  nothing  that,  in  case  of 
occasional  retention,  could  be  likely  to  prove  pre- 
judicial to  the  system.  Mr.  Abernethy*  found 
the  aeriform  discharge  from  the  skin  to  consist  of 
carbonic  acid  gas  and  azotic  gas  ;  the  former  con- 
stituting somewhat  more  than  two  thirds,  and  the 
latter  a  little  less  than  one  third.  Neither  of  these 
gases  can  be  supposed  to  be  noxious  in  the  quan- 
tity retained  by  a  temporary  suppression  of  the 
cutaneous  perspiration.  Carbonic  acid  gas,  and 
the  materials  of  which  it  is  composed,  are  always 
present,  in  considerable  quantity,  in  the  animal 
constitution ;  carbon  is  one  of  the  principal  ingre- 
dients of  food ;  carbonic  acid  gas  is  plentifully 
found  in  a  variety  of  the  common  fermented  li- 
quors ;  and  it  is  known  to  be  an  efficacious  reme- 
dy in  many  diseases. — Azotic  gas  is  the  most 
abundant  ingredient  in  the  atmosphere  ;  in  a  va- 
riety of  ways  it  gains  admittance  into  the  system, 
and  enters  largely  into  the  composition  of  animal 
matter  :  and,  though  it  may,  in  some  instances, 
.morbidly  predominate  in  the  body,  it  is  certainly. 

Surgical  and  Philosophical  Essays,  part  ii. 
2  o 


306     Remarks  on  Cutaneous  Perspiration. 

on  the  whole,  to  be  considered  rather  as  a  nutri- 
tious than  a  noxious  or  excrementitious  substance. 
In  examining  the  perspirable  matter,  under  the 
aqueous  form,  Mr.  Abernethy  observed  it  to  be  a 
limpid,  tasteless  water ;  after  evaporation  of  one 
half,  it  had  a  very  slight  saline  taste  ;  no  change 
appeared  after  standing  many  days  ;  and  the  mix- 
ture of  some  of  the  most  noted  agents  in  chemis- 
try produced  no  visible  alteration. 

If  the  foregoing  facts  and  reasoning  are  well- 
founded,  it  must  be  concluded  that  the  powers 
and  usefulness  of  sudorifics  in  fevers,  have  been 
misunderstood,  and  that  great  abuses  have  arisen 
in  conducting  the  practice  of  them.  According- 
ly, some  of  the  most  judicious  practitioners  have 
always  inveighed,  with  great  force,  against  these 
abuses  ;  their  remonstrances  have  produced  much 
conviction,  and  effected  many  salutary  restraints. 
In  opposing  the  common  practice  respecting  su- 
dorifics, it  will  be  understood,  that  reference  is 
generally  intended  to  that  kind  of  sweating  which 
is  excited  by  forcible  means,  by  the  application  of 
external,  or  the  confinement  of  bodily  heat,  or  by 
the  internal  use  of  substances  directiy  stimulant. 
When  excited  by  emetics,  in  nauseating  or  full 
doses,  or  by  any  other  means  which  directly  di- 
minish action  in  the  system,  it  is  understood  to 
be  an  effect  of  a  different  kind,  and  not  liable 
to  the  objections  now  offered  to  the  practice  of 
forcing  sweats. 


Remarks  on  Cutaneous  Perspiration.     30? 

Inflammatory,  malignant,  and  pestilential  fevers 
exhibit  some  of  the  most  striking  instances  in 
which  sudorific  remedies  have  been  recommend- 
ed, and  in  which  they  have  produced  the  most 
pernicious  abuses.  Experience,  though  ample 
and  impressive,  has,  by  no  means  universally  cor- 
rected  this  error.  And  as  this  country,  for  seve- 
ral years  past,  has  been  unhappily  subjected  to 
epidemic  fevers  of  this  description,  not  only  pre- 
sumed mistakes  in  the  treatment  of  them,  but  er- 
roneous opinions  also,  become  interesting  matter 
of  disquisition. 

The  ravages  of  the  fevers  just  mentioned  are 
but  too  well  known.  Without  undertaking  to 
inquire  into  all  the  modes  in  which  a  fatal  termi- 
nation of  them  may  be  apprehended,  there  are  two 
which  probably  will  not  be  controverted — 1st. 
Organic  derangement  of  some  viscus  essential  to 
life — or,  2dly.  General  exhaustion  of  vital  power, 
or  the  principle  of  excitability.  The  former  is 
commonly  effected  by  the  violent  impetus  of  the 
blood's  circulation,  determined  to  particular  vis- 
cera, and  accomplishing  the  fatal  event  by  the  in- 
strumentality of  congestion,  engorgement,  effu- 
sion, &c. ;  and  the  latter,  by  that  excess  of  stimula- 
tion which  is  the  sum  of  all  the  inordinate  actions 
resulting  from  the  disease. 

No  person  can  deny  that  sudorifics,   operating 


308     Remarks  on  Cutaneous  Perspiration. 

by  means  of  external  heat,  or  other  direct  stimu- 
lants externally  or  internally  administered,  have  a 
tendency  to  produce  or  to  aggravate  such  effects. 
The  disease  itself  manifests  a  strong  disposition 
to  exert  its  violence  in  this  topical  derangement, 
even  when  moderated  by  all  the  remedies  best 
adapted  to  allay  excessive  action.  The  delicate 
texture  of  many  of  the  viscera  is  ill  suited  to  re- 
pel an  attack,  from  which  even  the  strongest  can 
scarcely  escape  without  a  fatal  breach.  To  at- 
tempt to  excite  sweating  by  powerful  stimulants, 
in  this  state  of  the  system,  without  copious  evacu- 
ations from  the  blood-vessels  and  bowels  previous- 
ly used,  is  as  preposterous  as  to  endeavour  to  ex- 
tinguish flame  by  the  pouring  on  of  oil. 

And  if,  instead  of  a  fever  of  such  destructive 
impetuosity,  another  present  itself,  distinguished 
by  debility,  prostration,  and  all  the  symptoms  of 
exhausted  excitability,  what  benefit  can  be  ex- 
pected from  a  remedy  calculated  directly  to  ag- 
gravate the  disease,  and  to  hurry  on  the  fatal 
event  ?  By  the  operation  of  sudorifics,  not  only 
the  capillary  vessels  of  the  skin,  but,  through  the 
medium  of  sympathetic  association,  all  other  parts 
of  the  secerning  and  arterial  system  are  excited  to 
greater  action  ;  but  the  smallest  increase  of  fibrous 
contraction  cannot  be  produced  without  a  corres- 
pondent expenditure  of  vital  power,  or,  in  other 
words,  a  correspondent  increase  of  the  disease 


Remarks  on  Cutaneous  Perspiration.     309 

With  all  the  saving  of  the  principle  of  excitability 
which  the  most  cautious  management  is  able  to 
effect,  the  feeble  and  exhausted  frame  can  scarce-, 
ly  sustain  the  functions  of  life  : — why  then  dimi- 
nish, by  an  exhausting  remedy,  what  is  already 
too  scanty,  and,  at  the  same  time,  all  important  to 
existence  ? 

It  is  by  no  means,  however,  intended  to  assert 
that  sudorifics  are  always  useless  or  pernicious. 
On  the  contrary,  they  may  be  very  advantageously 
employed  to  obviate  the  return  of  the  cold  pa- 
roxysm of  fevers  :  they  will  render  great  service 
in  many  chronic  diseases  attended  with  general 
debility,  and  especially  with  cold  and  pale  skin  -x 
they  will  form  a  remedy  of  great  importance  in 
many  cases,  by  producing  a  transfer  of  excitement 
from  the  diseased  part  or  organ,  to  the  skin — and 
in  a  multitude  of  other  instances  not  necessary  to 
be  mentioned  here. 

Even  in  fevers,  sudorifics  may  be  frequently 
employed  with  success.  The  cure  which  nature 
has  provided  for  the  increased  exertion  of  the  sys- 
tem, consists  in  the  consequent  expenditure  of 
excitability.  All  cases  of  fevers,  occurring  during 
the  prevalence  of  mortal  epidemics,  are  not  equal- 
ly malignant ;  on  the  contrary,  many  instances  of 
a  mild  and  transient  disease  are  observed  even  in 
the  plague ;  and,  in  the  yellow  fever,  this  still 


310     Remarks  on  Cutaneous  Perspiration 

oftener  takes  place.  On  this  point,  it  is  probable, 
the  efficacy  and  reputation  of  sudorifics  will  be 
found  to  rest.  In  all  such  febrile  cases,  therefore, 
as  are  moderate  in  their  attack,  as  do  not,  on  the 
one  hand,  by  the  violence  of  re-action,  threaten 
local  organic  destruction — nor,  on  the  other,  rapid- 
ly exhaust  the  principle  of  excitability,  sweating 
may  be  excited  with  safety,  and,  if  used  early  in 
the  disease,  may  often  speedily  terminate  it  with 
complete  success.  And  even  in  fevers  of  greater 
violence,  after  sufficient  evacuations  from  the 
blood-vessels  and  intestines,  the  operation  of  su- 
dorifics may  be  sometimes  efficacious,  by  gradu- 
ally expending  the  morbid  surplusage  of  excitabi- 
lity— by  invigorating  the  absorbent  function,  and 
thereby  obviating  the  tendency  to  engorgement 
and  effusion — by  the  mitigation  of  heat  arising 
from  the  evaporation — and,  finally,  by  that  agree- 
able softness  and  relaxation  of  the  skin,  which 
commonly  attends  the  aqueous  form  of  perspira- 
tion. These  advantages  will  often  more  than 
compensate  for  the  addition  of  stimulus  which  su- 
dorifics impart  to  the  system. 

The  efficacy  of  this  class  of  remedies,  in  rheu- 
matism, has  been  supposed  to  afford  the  most  de-" 
cisive  and  triumphant  testimony  of  their  virtue. 
Long  experience,  and  a  comparison  of  this  mode 
of  treatment  with  many  others,  leave  no  room  to 
doubt  the  propriety  of  the   preference  give- 


Remarks  on  Cutaneous  Perspiration.     311 

them.  Still,  however,  it  may  be  justly  contended, 
that  the  operation  of  sudorifics,  in  this  instance,  is 
chiefly  indirect ;  that  their  usefulness  greatly  de- 
pends on  the  preparation  of  the  system  by  previous 
remedies ;  and  that  this  example  affords  only  am- 
biguous ground  for  extending  the  employment  of 
them  as  a  general  remedy  in  fevers. 

Sudorifics  in  rheumatism  appear  gradually  to 
expend  the  superabundant  excitability,  by  the  in- 
creased action  they  induce  ;  which  may  be  effect- 
ed the  more  safely  in  this  manner,  as  the  seat  and 
disposition  of  the  disease  give  no  reason  to  ap- 
prehend a  derangement  of  the  vital  organs.  It  is 
probable  this  remedy  does  much  also,  in  this  dis- 
ease, by  increasing  the  energy  of  absorption.  If 
used  early  in  the  disease,  without  considerable 
previous  evacuations  by  bleeding  and  cathartics, 
it  is  said  evidently  to  protract,  and  primarily  to 
exasperate  the  pain  and  other  symptoms.  It 
must,  indeed,  be  admitted,  that  this  remedy  will 
often  alone  effect  a  cure,  on  the  principle  before 
mentioned,  if  the  long  and  painful  process  neces- 
sary in  such  a  circuitous  plan  of  treatment  can  be 
resolutely  persisted  in.  That  it  acts  chiefly  by 
increasing  absorption,  is  rendered  probable  by  its 
distinguished  efficacy,  when  employed  immediate- 
ly after  the  inanition  induced  by  blood-letting  and 
cathartics  ;  and  this  opinion  is  confirmed  by  ob- 
serving that  the  most  copious  and  repeated  bleed 


312     Remarks  on  Cutaneous  Perspiration. 

ing  and  purging  will  not  readily  relieve  rheuma- 
tism,  unless  sudorifics,  mercury,  Peruvian  bark, 
or  some  other  remedy  suited  to  increase  the  ener- 
gy of  the  absorbents,  be  speedily  superadded. 
The  same  opinion  is  also  further  corroborated  by 
the  success  of  compression  by  bandages,  in  dis- 
cussing any  obstinate  remainder  of  the  disease, 
affecting  the  limbs,  after  sudorifics,  &c.  preceded 
by  blood-letting  and  cathartics,  had  been  faithful- 
ly employed. 

Notwithstanding  these  concessions  in  favour  of 
sudorifics,  it  may  justly  be  insisted  upon,  that  per- 
spiration, carried  to  the  extent  of  sweating,  is  ge- 
nerally, more  or  less,  a  sign  of  indirect  debility. 
Few  animals  exercise  themselves  so  as  to  induce 
visible  sweat,  unless  compelled  by  mankind,  by 
the  apprehensions  of  fear,  or  the  cravings  of  hun- 
ger. The  debilitating  effects  of  it  are  to  be  con- 
stantly observed  in  the  human  system.  Witness 
the  languor  produced  by  exercise  in  warm  wea 
ther,  especially  in  persons  unaccustomed  to  ex- 
ertion in  the  heat ;  and  yet  more  in  labourers,  in 
hot  climates,  after  vigorous  toil,  and  profuse 
sweating,  through  the  day.  Witness  the  pale  and 
sickly  countenances,  and  short  lives,  of  workmen 
whose  occupations  condemn  them  to  endure  high 
degrees  of  heat,  as  in  furnaces,  glass-houses,  &c. 
The  inhabitants  of  hot  climates,  who  perspire  pro 
fusely,  are  defective  in  vigour,  and  generally  short. 


Remarks  on  Cutaneous  Perspiration.     313 

lived  ;  the  waste  of  excitability  in  the  excessive 
and  useless  exertions  of  the  cutaneous  vessels,  is 
probably  one  principal  ground  of  premature  infir- 
mity, and  of  short  life.* 

That  sudorifics  cannot  he.  usefully  employed  as 
a  general  remedy  in  fevers,  is  apparent  from  the 
fatal  course  pursued  by  many  of  these  diseases, 
notwithstanding  the  most  copious,  universal,  and 
continued  sweats  spontaneously  taking  place. 
The  memorable  sweating  sickness,  which  first 
appeared  in  England  towards  the  close  of  the  fif- 
teenth century,  and  was  one  of  the  most  fatal 
epidemics  on  medical  record,  affords  ample  proof 
of  this  position. 

On  the  whole,  it  may  be  concluded,  that  much 
of  the  use  of  sudorifics  has  arisen  from  mistaken 
doctrines  concerning  the  nature  of  perspiration 
and  of  fever — particularly  from  the  erroneous 
opinions,  that  the  matter  of  perspiration  is  excre- 
mentitious ;  that  its  occasional  obstruction  is  nox- 

*  M.  Buffon  made  a  curious  experiment  to  show  this  cir- 
cumstance. He  took  a  numerous  brood  of  the  butterflies  of 
silk-worms,  some  hundreds  of  which  left  their  eggs  on  the 
same  day  and  hour  :  these  he  divided  into  two  parcels ;  and 
placing  one  parcel  in  the  south  window,  and  the  other  in  the 
north  window  of  his  house,  he  observed  that  those  in  the 
colder  situation  lived  many  days  longer  than  those  in  the 
warmer  one.     Darwin's  Zoonomia,  vol.  ii,  p.  2£. 

2  R 


314     Remarks  on  Cutaneous  Perspiration, 

ious  ;  that  it  ought,  as  much  as  possible,  to  be 
eliminated  from  the  system  ;  and  that  it  is  only- 
carried  off  in  considerable  quantity  when  discover- 
able by  sight  or  touch. 

It  may  be  also  concluded,  that  sudorific  reme- 
dies, especially  those  of  more  powerful  kind,  are, 
in  general,  highly  unsafe,  and  calculated  to  augment 
the  violence  of  inflammatory  and  malignant  fevers  ; 
and  that,  although  they  may  succeed  in  some 
cases  of  less  violence,  or  by  a  favourable  con- 
currence of  circumstances,  yet  they  are  so  con- 
stantly liable  to  produce  mischief,  and  exasperate 
the  disease,  that  the  abuse,  on  the  whole,  must  be 
pronounced  greatly  to  exceed  the  use. 

After  this  attempt  to  restrict  the  use  of  sudorific 
remedies  to  such  narrow  limits,  it  may  not  be 
improper  to  recall  the  reader's  attention  to  a  sub- 
stitute better  adapted  to  the  nature,  circumstances, 
and  varieties  of  fevers.  This  substitute  is  water, 
of  various  temperature,  taken  into  the  stomach, 
injected  into  the  bowels,  and  applied  to  the  surface 
of  the  body.  Many  endeavours  have  been  made 
to  bring  this  inestimable  remedy  into  more  com- 
mon use;  hitherto,  indeed,  without  much  success  ; 
but  it  is  to  be  hoped  that  the  time  now  approaches 
when  its  efficacy  will  no  longer  be  disdained  or 
account  of  its  simplicity  and  cheapness. 


Remarks  on  Cutaneous  Perspiration.     3 IS 

The  causes  of  fever  would  be  infinitely  less 
pernicious  to  the  system,  if  the  fever  itself  were 
repressed  in  its  first  movement,  or  annihilated  in 
embryo.  The  cool  treatment  of  the  small- pox 
gives  an  example  of  this  suppression  of  a  disease ; 
but  physicians  have  never  yet  sufficiently  availed 
themselves  of  the  instruction  it  affords.  Notwith- 
standing all  the  complicated  maxims  and  rules  of 
medical  practice,  the  genuine  treatment  of  fevers 
is  simple  ;  it  chiefly  consists  in  reducing  the  heat 
of  the  system  when  too  high,  and  increasing  it 
when  too  low  :  the  former  will  allay  the  existing 
excessive  action,  which  threatens  organic  destruc- 
tion of  the  more  important  and  delicate  viscera,  or 
an  eventual  exhaustion  of  the  principle  of  life  ; 
and  the  latter  will  obviate  such  accumulation  of 
excitability  as  may  endanger  the  system  from  the 
violence  of  subsequent  re-action.  The  element 
of  heat,  one  of  the  most  universal  and  enlivening 
agents  yet  discovered  in  nature,  which  surrounds 
and  pervades  all  bodies,  and  regulates  many  of  the 
principal  circumstances  of  animal  and  vegetable 
life,  deserves  a  primary  attention  in  the  manage- 
ment of  fevers.  Excepting  a  few  precipitate  cases, 
where  the  noxious  cause  mounts,  at  once,  to  the 
source  of  life,  and  suddenly  extinguishes  the  vital 
principle,  it  will  be  found  that  heat  is  the  chief 
instrument  by  which  the  febrile  poison  executes 
its  destructive  work.  Heat  and  the  arterial  tumult 
reciprocally  sustain  the  relation  of  cause  and  effect, 


316     Remarks  on  Cutaneous  Perspiration. 

and  too  often  proceed  in  augmenting  each  other 
till  life  is  destroyed. 

It  is  by  no  means  intended  to  undervalue  the 
importance  of  depleting  remedies  in  excessive 
arterial  action  ;  they  are  often  indispensable  ;  they 
deserve  the  highest  confidence  ;  and,  especially 
as  preparative  for  the  use  of  other  means,  they 
must,  till  medicine  advance  some  steps  further, 
generally  lay  the  ground- work  of  the  treatment. 
But  a  great  proportion  of  the  depletion  otherwise 
necessary  might  be  spared  by  the  adoption  of  the 
pleasant,  simple  and  powerful  application  now  re- 
commended. 

If,  indeed,  the  sick  could  always  avail  them- 
selves of  the  utmost  efficacy  of  water,  it  might, 
perhaps,  become  as  universal  an  extinguisher  of 
fever  as  of  fire.  The  use  of  cool  air,  \n  fevers, 
forms  an  aera  in  the  history  of  medicine.  The  use 
of  water,  cold,  tepid  or  hot,  so  as  to  suit  the  va- 
rying degrees  of  heat  intended  to  be  diminished  or 
increased,  may  form  an  asra  of  greater  importance. 
If  too  much  action  prevail  in  any  part,  or  in  the 
whole  system,  it  may  always  be  speedily  reduced 
by  water  of  appropriate  temperature.  If  chilliness 
and  torpor  are  found  in  particular  parts,  or  in  the 
whole,  the  partial  or  general  application  of  water, 
of  proper  warmth  will  be  one  of  the  most  direct 
and  expeditious  means  of  procuring  relief.     In 


Remarks  on  Cutaneous  Perspiration.     317 

most  fevers,  the  action  of  the  sanguiferous  vessels 
is  plainly  either  excessive  or  deficient ;  and  so 
close  a  dependence  has  this  morbid  action  upon 
the  heat  of  the  body,"  that  a  steady  and  efficient  re- 
gulation of  that  heat,  lowering  excess  and  supply- 
ing defect,  would  certainly  bring  that  action  to 
a  proper  point,  and  there  render  it  stationary. 

Cool  air  has  been  justly  deemed  an  invaluable 
remedy  in  fevers  ;  but  air  is  comparatively  a  bad 
conductor  of  heat.  Irreparable  mischief  may  be 
produced  before  it  can  adequately  operate ;  and,  in 
some  seasons  and  countries,  it  would  be  impossi- 
ble to  obtain  it  of  the  requisite  degree  of  coldness. 
Water,  eight  hundred  times  denser  than  air,  and 
conducting  heat  with  proportionable  celerity,  must 
be  much  better  adapted  to  produce  a  powerful 
effect  in  the  system.  The  force  and  rapidity  of 
the  operation  of  cold  water  may  be  estimated  by 
considering  the  consequence  of  plunging  a  person, 
in  perfect  health,  whose  excitement  is  supported 
by  every  due  degree  of  stimulus,  naked,  into  wa- 
ter of  a  degree  of  cold  at  or  under  the  freezing 
point.  Life  would  be  almost  instantaneously  ex- 
tinguished. And  if  this  extreme  effect  could  be 
so  suddenly  induced,  is  there  not  sufficient  war- 
rant to  assert,  that  all  inferior  effects  might  be 
produced  by  a  cautious  and  graduated  application 
of  the  same  remedy  ? 


318     Remarks  on  Cutaneous  Perspiration. 

There  is  good  reason  to  believe  that  hot  weather 
and  febrile  diseases  increase  the  heat  much  more 
upon  the  surface  than  in  the  internal  parts  of  ihe 
body,  where  the  temperature*  is  nearly  stationary. 
Mr.  Hunter's  experiments  on  the  heat  of  animals, 
as  existing  in  inflammation  of  various  parts  of  the 
body,  and  measured  by  the  thermometer,  establish 
this  fact.* 

The  skin  is  more  susceptible  of  increased  heat, 
in  diseases,  than  any  other  part,  because,  in  a  state 
of  health,  it  is  actually  cooler,  and,  of  consequence, 
possesses  a  greater  accumulation  of  irritability 
than  the  internal  parts.  The  comparative  cool- 
ness of  the  skin  must  be  ascribed  to  its  exposure 
to  a  medium  commonly  much  cooler  than  itself, 
and  to  the  quantity  of  heat  continually  absorbed 
and  borne  off  by  the  evaporation  of  the  perspira- 
ble matter.  And  perhaps  it  may  be  true,  with 
respect  to  the  cold  as  well  as  the  hot  stage  of  fever, 
that  the  skin  is  principally  and  extraordinarily  af- 
fected. 

If,  then,  it  be  admitted,  that  the  operation  of 
heat  is  so  important  and  mischievous  in  febrile 
diseases,  and,  likewise,  that  this  excessive  heat  is 
chiefly  exerted  upon  the  superficial  parts  of  the 

*  Hunter's  Treatise  on  (he  Blood,  Inflammation,  and  Gun- 
shot Wounds,  vol.  ii.  p.  20. 


Remarks  on  Cutaneous  Perspiration.     319 

body,  a  great  additional  encouragement  is  derived 
to  rely  upon  the  efficacy  of  the  application  of 
water. 

But,  in  order  to  give  the  sick  the  utmost  ad- 
vantage of  this  remedy,  and  to  avoid  laying  too 
much  of  the  stress  of  its  operation  upon  particular 
stages  of  febrile  affections,  these  affections  must 
be  surveyed  in  their  utmost  latitude,  and  appro- 
priate degrees  of  heat  or  cold  applied  to  the  skin 
and  other  parts  at  seasonable  periods.  For  ex- 
ample— the  application  of  heat,  in  the  torpid  or 
cold  stage  of  fever,  is  as  important  as  that  of  cold 
in  the  hot  stage  ;  and,  by  attending  promptly  to 
the  former,  more  efficacy  and  less  difficulty  will 
be  found  in  the  latter.  By  neglecting  the  former, 
the  disease  strikes  a  deeper  root,  time  is  lost,  and 
much  more  energy,  or  rather  violence,  is  requi- 
site in  the  subsequent  measures. 

Not  only  warm  water,  but,  perhaps,  other  ex- 
ternal stimulants,  might  be  usefully  employed  in 
arresting  the  cold  stage  of  fevers  :  among  these 
may  be  reckoned  alcohol,  spirit  of  ammonia, 
aether,  &c.  which  may  always  be  kept  ready  for 
immediate  use,  and  whose  application  to  the  skin 
could  be  productive  neither  of  trouble  nor  danger. 
The  doctrine  of  the  hot  being  a  natural  and  ne- 
cessary consequence  of  the  cold  fit,  and  the  com- 


320     Remarks  on  Cutaneous  Perspiration. 

mon  appearance  of  proportion  between  them,  in 
extent,  degree  or  duration,  give  countenance  to 
the  use  of  this  kind  of  remedy.  The  usefulness 
of  arterial  compression,  as  recommended  by  Mr. 
Kellie,*  in  lessening  and  shortening  the  cold  stage 
of  intermittents,  and,  by  consequence,  the  whole 
paroxysm,  suggests  another  remedy  of  similar 
kind,  and  strongly  confirms  and  illustrates  the 
general  principle. 

With  respect  to  the  precise  temperature  of 
water,  applied  externally  or  internally  at  the  dif- 
ferent stages  of  a  febrile  paroxysm,  alternately  to 
restrain  defect  and  excess  of  heat,  much  is  pro- 
bably yet  to  be  learned.  In  general,  it  may  be 
observed  that  a  degree  of  heat  from  96  to  100  of 
Fahrenheit's  thermometer,  will  be  necessary  in  the 
stage  of  chilliness ;  and,  in  the  hot  stage,  95,  or 
any  inferior  degree,  as  prudence  may  dictate,  will 
produce  a  cooling  effect.  The  use  of  very  cold 
water  will  probably  be  seldom  necessary  or  ad- 
visable ;  as  too  sudden  transitions  from  high  to 
low  temperatures  are  not  requisite  to  produce  the 
desired  effect,  and,  in  some  cases,  may  possibly 
be  productive  of  mischief. 

The  mode  of  applying  water  of  various  tem- 
perature to  the    skin  of  sick  persons,    without 

*  Duncan's  Medical  Commentaries  vol.  six.  p.  155. 


Remarks  on  Cutaneous  Perspiration.     321 

obliging  them  to  leave  their  beds,  and  without  in- 
ducing the  least  fatigue,  opens  a  wide  range  for 
the  exertion  of  ingenuity  and  invention.  Sheets 
of  oiled  silk  might  probably  be  used  for  this  pur- 
pose with  great  advantage  ;  and  the  application  of 
blankets  and  sheets,  or  body-linen,  previously 
wrung  out  of  water,  at  the  same  time  causing  a  pro- 
per degree  of  ventilation  to  be  maintained,  would 
regulate  at  pleasure  the  heat  of  the  patient's  skin.* 
Damp'  or  wet  linen  and  sheets  would,  in  this  case, 
produce  exactly  the  same  effect,  employed  as  a 
remedy,  which  they  produce  in  bringing  disease 
upon  healthy  persons :  the  different  relative  cir- 
cumstances of  the  body,  in  health  or  in  fever, 
form  a  substantial  difference,  and  render  the  same 
application,  in  one  case,  highly  pernicious,  and, 
in  the  other,  highly  salutary. 

The  appropriate  temperature  of  the  water,  varied 
with  every  change  in  the  condition  of  the  system, 
and  always  regulated  with  the  greatest  exactness 
of  graduation,  will  supersede  the  necessity  of  ma- 
ny cautions   and  restrictions   in  the   application, 

*  Examples  of  the  remarkable  efficacy  of  the  external 
application  of  water  may  be  found  in  Bruce's  Travels  to  dis- 
cover the  Source  of  the  Nile,  vol.iii,  p.  33;  in  Dr.  Jackson's 
Treatise  on  the  Fevers  of  Jamaica,  p.  270 ;  in  Dr.  Rush's  Medical 
Inquiries  and  Observations,  vol.  iv,  p.  92;  and  especially  in 
Dr.  Currie's  Medical  Reports  on  the  Effects  of  Water.  SfC.  Li 
verpool,  8vo.  1798. 

2  s 


322     Remarks  on  Cutaneous  Perspiration. 

concerning  the  particular  stage  of  the  paroxysm, 
the  chilliness  or  heat  of  the  skin,  the  presence  of 
perspiration,  &c.  which  would  demand  much 
minuteness  of  detail,  and  exceed  the  limits  pre- 
scribed to  this  inquiry. 


REMARKS 


ON    THE 


EFFECTS  OF  ABSTINENCE 

AT  THE  APPROACH 


OP 


ACUTE  DISEASES, 


TO 
VALENTINE  SEAMAN,  M.  D. 

Professor  of  Anatomy,  Physiology  and  Surgery,  in  the 
Medical  Institution  of  the  State  of  New-York. 


Dear  Sir, 

THE  long  and  uninterrupted  friendship 
which  subsisted  between  You  and  the  Writer  of 
the  following  Essay  ;  and  the  spontaneous  and 
fraternal  tribute  of  respect  which  You  paid  to  his 
memory,  ought  never  to  be  forgotten  by  his  sur- 
viving relatives. 

Allow  me,  in  this  page,  to  record  an  humble 
memorial  of  a  friendship  which  I  have  every  rea- 
son to  believe  was  highly  valued  on  both  sides ; 
and  to  express  the  respectful  and  grateful  senti- 
ments with  which  I  am,  dear  sir, 

Your  sincere  friend, 

THE  EDITOR. 


Princeton,  N. 
March  21,  1814 


ii 


REMARKS,  &c. 


1  HE  following  fact  seems  to  deserve  more 
attention  than  it  commonly  obtains.  In  a  dis- 
trict of  the  United  States,  distinguished  for  the 
prevalence  of  the  epidemic  diseases  of  summer 
and  autumn,  it  is  often  asserted,  by  sensible  and 
accurate  observers,  that  they  are  accustomed  to 
obviate  the  attack  of  fevers,  apparently  approach- 
ing, by  rigid  abstinence  from  food.  This  absti- 
nence, begun  as  soon  as  they  perceive  the  feelings 
of  indisposition,  usually  known  to  be  the  forerun- 
ners of  fever,  is  continued  till  such  feelings  cease, 
till  appetite  is  restored,  and  generally,  indeed,  till 
the  calls  of  hunger  become  importunate.  Oa 
different  occasions,  this  process  is  of  various  du- 
ration ;  sometimes  occupying  twenty-four,  thirty- 


328  Remarks  on  Abstinence. 

six,  or  even  forty-eight  hours,  according  to  the 
nature  and  exigencies  of  the  case.  The  success 
of  this  regimen  is  commended  by  such  as  have 
experienced  it,  in  stronger  terms  than  it  would  be 
proper  here  to  repeat,  and,  perhaps,  stronger  than 
the  reality  of  the  case  can  justify.  It  is  not,  how- 
ever, difficult  to  perceive  that  much  fallacy  may 
be  mingled  with  this  sort  of  experience.  Com- 
plaints, similar  to  these  in  question,  are  often 
transient,  when  every  attention  to  regimen  has 
been  omitted.  What  criterion,  then,  shall  be 
resorted  to,  for  the  purpose  of  distinguishing 
these  fugitive  symptoms,  originating  from  indi- 
gestion or  some  still  more  fleeting  cause,  from  the 
serious  ones,  which,  if  neglected,  will  usher  in  a 
severe  disease  ?  This  ground  of  uncertainty  is 
freely  admitted.  But  still  it  remains  probable, 
that  there  is  much  truth  in  the  observation,  par- 
ticularly when  we  call  to  mind  the  number,  saga- 
city, and  concurrence  of  the  observers,  the  accu- 
racy of  personal  experience,  and  the  multiplied 
instances  which  epidemic  sickness  affords  for 
comparison  and  discrimination.  And  I  am  fur- 
ther inclined  to  give  credit  to  this  observation, 
because  it  appears  to  depend  upon  principles  of  the 
animal  economy,  which  are  of  great  importance, 
and  admit  of  an  easy  explanation. 

Although    the   observation   above-mentioned 
comes,    in  the  present  instance,   from  a  popular 


Remarks  on  Abstinence.  329 

source,  the  effects  of  abstinence,  in  obviating  the 
approach  of  acute  diseases,  have  not  escaped  the 
notice  of  the  most  eminent  physicians.  In  the 
writings  of  Hippocrates,  we  perceive  the  strong 
impression  he  had  received  on  the  subject.  Sy- 
denham is  still  more  explicit.  In  his  account  of 
the  continued  fever  of  the  years  1673,  1674,  and 
1675,  considered  by  Dr.  Cullen  as  a  variety  of 
Synocha,  or  inflammatory  fever,  it  is  asserted  that 
he  often  cured  this,  as  well  as  other  fevers,  in  the 
beginning,  merely  by  directing  diluents,  and  pro- 
hibiting every  kind  of  aliment.  Thus  he  relieved 
his  children  and  intimate  friends  (to  use  his  own 
words)  by  making  them  fast  strictly  for  two  or 
three  days. — And,  besides  medical  authority,  we 
may  also  adduce,  in  favour  of  this  mode  of  pre- 
venting diseases,  the  recommendation  and  prac- 
tice of  many  men  of  letters,  who  have  adopted  it 
with  the  greatest  zeal.  The  sedentary  lives  of 
such  persons,  diminishing  keenness  of  appetite, 
and  augmenting  the  burden  of  repletion,  and  their 
experience  of  higher  intellectual  power  in  a  some- 
what diminished  degree  of  bodily  vigour,  may, 
perhaps,  account  for  their  attachment  to  this  re- 
medy.* 

*  Among  many  examples  of  literary  persons,  who  have 
practised  rigid  abstinence,  and  derived  great  benefit  from 
it,  I  shall  mention  the  late  Rev.  Dr.  Campbell,  Principal 
of  Marischal  College  and  the  University  of  Aberdeen,  who 
♦lied  in  1795.  aged  71  years.     "  He  had.  all  his  life,  a  rooted 

2   T 


330  Remarks  on  Ahstinence. 

The  advantages  of  total  abstinence,  at  the  com- 
mencement of  acute  diseases,  bear  an  evident  re- 
lation to  the  effects  of  a  temperate  and  abstemious 
diet,  during  the  prevalence  of  fatal  epidemics. 
The  long  experience  of  countries  subject  to  the 
visitation  of  pestilential  diseases,  and  of  several 
parts  of  our  own  country,   under  the  pressure  of 

"  aversion  to  medicines.  He  got  the  better  of  every  ailment, 
"  by  a  total  and  rigorous  abstinence  from  all  kind  of  sustenance 
"  whatever;  and  it  was  not  till  he  was  attacked  by  an  alarming 
"  illness,  about  two  years  before  his  death,  that  he  was  per- 
"  suaded  by  his  friends  to  call  in  medical  aid.  What  natun 
"  could  do,  she  had  all  along  performed  well ;  but  her  day 
"  was  over;  and  something  of  art  became  necessary. — Then, 
"  for  the  first  time,  he  owned  the  utility  of  medical  men,  and 
"  declared  his  recantation  of  the  very  mean  opinion  he  had 
"  formerly  entertained  of  them  and  their  art." — London 
Monthly  Mag.  vol.  i,  p.  344. 

Whatever  mistakes  may  appear  in  such  opinions,  it  is 
interesting,  in  all  the  concerns  of  health  and  diseases,  where 
facts  and  the  unbiassed  examination  of  them  are  so  important, 
to  observe  the  conclusions  formed  by  discerning  men,  who 
are,  at  the  same  time,  divested  of  the  prejudices  incidental  to 
the  medical  profession.  While  on  the  one  hand,  physicians 
possess  superior  advantages  in  acquiring  knowledge  of  the 
nature  and  cure  of  diseases,  on  the  other,  they  are  peculiarly 
exposed  to  certain  sources  of  error.  Systems  collect,  com- 
bine, generalize,  and  interpret  facts ;  but  they  also,  sometimes, 
distort  and  mutilate  them.  Hence  the  common  sense  of  man- 
kind, and  more  especially  the  discernment  of  vigorous  minds, 
13  a  necessary  corrective  of  that  obliquity  with  which  even 
simple  objects  are  sometimes  beheld  by  the  systematica? 
devotee. 


Remarks  on  Abstinence.  331 

recent  or  existing  calamities  of  a  similar  kind, 
places  the  benefits  of  this  diet  in  a  strong  light. 
Not  only  the  caution  of  individuals,  but  the  ha- 
bits of  nations  may  be  distinguished  in  the  com- 
parative exemption  from  diseases,  whieh  they 
derive  from  abstemiouMiess.  The  French  and 
Spaniards  in  the  West- Indies,  and  in  other  warm 
climates,  avoiding  the  use  of  ardent  liquors,  and 
retaining  their  usual  habits  of  thin  and  spare  diet, 
are  observed  remarkably  to  escape  the  dangers 
incidental  to  such  situations ;  while  the  British, 
carrying  with  them,  wherever  they  go,  not  only 
their  plethoric  and  vigorous  habits,  but  likewise 
their  national  predilection  for  a  gross  and  stimu- 
lant plan  of  living,  suffer  all  the  havoc  of  those 
baneful  countries.  From  every  tropical  region 
similar  examples  might  be  brought ;  and  wher- 
ever experience  has  enforced  accommodation  to 
the  inclemency  of  a  hot  climate,  we  observe  peo- 
ple relinquishing  all  such  excesses  and  grossness- 
es  of  diet  as  can  only  be  safely  indulged  in  the 
higher  latitudes. 

The  importance  of  the  functions  of  the  stomach 
in  the  animal  system  explains  the  powerful  effects 
of  abstinence  and  repletion.  No  animal  can  ex- 
ist without  a  stomach.  Deprived  of  brain,  heart 
and  lungs,  the  cold-blooded  animals  have  been 
observed  to  live  and  move  for  several  hours.  The 
languor  of  their  circulation,  their  occasional  ex- 


332  Remarks  on  Abstinence. 

crcisc  of  respiration,  and  a  portion  of  excita- 
bility singularly  inherent  and  inseparable,  enable 
them,  while  the  energies  of  the  stomach  continue, 
to  retain  life  without  the  aid  of  those  important 
organs.  And,  even  in  the  more  perfect  animals, 
the  functions  of  the  stomach  hold  so  distinguished 
a  rank,  that  life  has  remained  for  some  time  inde- 
pendently of  almost  every  other  part  of  the  bod}-. 
The  range  of  sympathy  which  it  possesses  with 
other  parts,  remote  as  well  as  contiguous,  is  so 
extensive,  that  it  is  emphatically  stiled  the  index 
of  the  whole  system.  Besides  its  importance  as 
the  principal  organ  of  assimilation,  we  observe  a 
great  number  and  variety  of  effects,  salutary, 
morbid  or  deleterious,  produced  by  different  sub- 
stances taken  into  it,  and  operating  on  its  sensible 
and  delicate  texture.  In  febrile  diseases  it  affords 
some  of  the  most  interesting  and  satisfactory  in- 
dications concerning  their  accession,  progress, 
remission,  crisis,  and  cure.*  And,  finally,  it 
possesses  singular  mobility,  or,  in  other  words,  a 
promptitude  to  suffer  more  defect  or  excess  of 
excitement  than  any  other  part  of  the  system — 
Such  is  the  organ — such  the  powerful  changes 
in  it,  and  thence  in  the  whole  system,  which  we 
propose  to  excite  by  occasionally  depriving  it  of 
the  accustomed  stimulus  of  aliment. 

Acute   diseases   invade  the   body  in   various 
*  Medical  Commentaries,  vol.  xviii,  p.  94. 


Remarks  on  Abstinence.  333 

ways ;  sometimes  suddenly  ;  oftener  by  gradual 
approach :  when  suddenly,  they  admit  not  of  pre- 
vention by  abstinence.  It  is  probable  much 
more  may  be  learned  by  future  observation  than 
is  at  present  known,  concerning  the  distant  ap- 
proach of  these  diseases,  and,  consequently,  the 
means  of  averting  the  danger  they  produce.  In 
the  mean  time,  it  would  be  fortunate  for  mankind 
if  they  were  disposed  to  avail  themselves  of  all  the 
notices  of  approaching  illness  already  well  under- 
stood. During  the  prevalence  of  epidemic  dis- 
eases, these  symptoms  should  be  watched  with 
especial  attention  ;  as,  upon  the  proper  manage- 
ment of  the  interval  between  them  and  the  actual 
formation  of  the  disease,  the  prevention  of  the 
evil,  and  the  safety  of  the  patient  will  often  de- 
pend. 

It  would  be  no  easy  task,  nor  is  it  necessary, 
to  point  out  all  the  symptoms  which  notify  the 
approach  of  acute  diseases.  There  seems  to  be 
so  much  reason  to  ascribe  indicial  functions  to 
the  stomach,  that  we  should  generally  look  to  that 
viscus  for  the  earliest  notices  of  impending  mis- 
chief. Accordingly,  some  accurate  observers 
mention  a  peculiar,  disagreeable  affection  of  the 
stomach,  difficult  distinctly  to  describe,  com- 
pounded of  nausea  and  anxiety,  as  generally  the 
first  morbid  sensation.  Then  follows  heaviness, 
lassitude,  languor,  debility,  oppression,  restless- 


334  Remarks  on  Abstinence. 

ness,  hcad-ach,  or  giddiness,  pain  in  the  back  or 
limbb,  perversion  of  taste,  flatulency,  irregularity 
of  the  intestinal  discharge,  loss  of  appetite,  or 
sometimes  great  keenness  of  it,  low  spirits  or  un- 
usual vivacity,  wakefulness  or  unusually  sound 
sleep.*  When  such  symptoms  as  these  occur, 
during  the  prevalence  of  an  epidemic  disorder, 
or  after  exposure  to  any  of  the  known  causes  of 
acute  diseases,  it  will  be  advisable  to  abstain  from 
all  aliment  for  a  proper  length  of  time,  and  if  this 
step  should  be  found  unavailing,  to  adopt  such 
farther  measures  as  the  nature  of  the  case  may 
require. 

Sensations  which  precede  the  invasion  of  acute 
diseases,  it  is  well  known,  are  often  mistaken  for 
symptoms  of  indigestion,  and  treated  accordingly. 
The  mischief  which  must  ensue  from  the  use  of 
ardent  spirits,  the  popular  remedy  of  indigestion, 
at  the  approach  of  a  malignant  fever,  or  any  in- 
flammatory disease,  will  be  readily  seen. 

All  alimentary  matter,  especially  of  the  animal 
kind,  taken  at  the  commencement  of  an  acute  dis- 
ease, is  fraught  with  mischievous  consequences. 
The  powers  of  digestion  are  either  impaired  or 
totally    suspended.      No    assimilation    nor   nou- 

*  The  stimulus  of  contagion  or  miasma,  in  certain  de- 
grees of  force,  may  evidently  produce  exhilarating  as  well 
as  soporific  effects. 


Remarks  on  Abstinence.  3S5 

rishment  can  take  place.  The  stimulus  of  the 
food,  immediately  on  its  arrival  at  the  stomach, 
will  be  added  to  the  morbid  stimuli,  previously 
operating  with  pernicious  violence.  Tottering 
under  its  present  load,  the  system  is  forced  to 
sustain  new  burdens.  But  this  is  not  the  only 
bad  effect  of  receiving  food  under  such  circum- 
stances. The  alimentary  matter,  unsubdued  and 
unassimilated  by  the  powers  of  digestion,  placed 
in  a  situation  where  it  must  undergo  a  rapid  and 
noxious  decomposition,  will  form  a  mass  of  cor- 
ruption and  acrimony,  generating  and  diffusing 
its  poison  throughout  the  whole  tract  of  the  sto- 
mach and  bowels.  Can  we  wonder,  after  this, 
to  hear  complaints  of  flatulency,  oppression,  and 
anxiety  about  the  prascordia,  pains  in  the  bowels, 
diarrhoea,  &c.  in  the  course  of  the  disease  ? 

Having  thus  stated  some  of  the  ill  consequen- 
ces of  food  received  into  the  stomach  at  the  com- 
mencement of  acute  diseases,  it  becomes  necessary 
to  avoid  these  consequences  by  abstinence  or  eva- 
cuations. Much  has  been  said,  by  practical 
writers,  on  the  efficacy  of  emetics,  exhibited  at 
the  approach  of  malignant  fevers  ;  and  there  is 
reason  to  assent,  in  general,  to  the  truth  of  these 
assertions.  But,  we  believe  that  abstinence  may 
often  be  advantageously  substituted  for  emetics  or 
other  evacuants  in  such  cases,  and  as  their  effects 
correspond  in  several  particulars,   and  seem  to 


336  Remarks  on  Abstinence. 

throw  light  on  each  other,  we  shall  venture  to 
consider  them  in  a  comparative  point  of  view. 

Emetics  produce  the  following  effects — they 
empty  the  stomach  and  the  upper  intestines — they 
accumulate  excitability  in  these  organs* — they  in- 
crease the  action  of  the  cellular,  pulmonary  and 
cutaneous  absorbents — and  they  promote  per- 
spiration, f 

*  That  emetics  accumulate  excitability,  is  proved  bj 
their  often  stopping  spontaneous  vomiting,  by  their  strength- 
ening digestion,  and  by  increasing  the  action  of  the  cellular, 
cutaneous,  and  pulmonary  absorbents,  during  their  operation. 
Zoonomia,  vol.  ii,  p.  57. 

f  There  are,  indeed,  other  considerable  effects  of  emetics, 
such  as  agitation  and  compression  of  the  abdominal  and 
thoracic  viscera,  thereby  increasing  the  force  of  circulation 
in  them,  and  promoting  their  several  secretions.  But  these 
effects  appear  to  hold  but  little  importance  in  preventing 
the  attack  of  fevers. — Dr.  Darwin,  "  in  his  theory  of  fever, 
"  supposes  that  emetics,  early  administered,  sometimes  cut. 
"  short  the  disease,  by  causing  a  retrograde  motion  of  the 
"  lacteals,  and  a  consequent  diminution  of  the  matter  of  con- 
"  tagiou.  Few  explanations  in  his  work  are  of  so  gross  and 
"  mechanical  a  cast.  We  conjecture  that  the  blow  must  be 
•'  given  to  the  stomach  before  the  subtile  matter  is  absorbed 
"  by  the  lacteals  :  we  should  not  be  surprised  if  these  ves- 
"  sels  were  rendered  incapable  of  action :  and  does  it  not 
':  appear  more  consonant  to  other  parts  of  the  author's  rea- 
"  soning,  to  suppose  that  vomits,  in  these  instances,  coun- 
"  teract  the  exhausting  effect  of  the  poison,  by  accumulating 
"  the  sensorial  power  of  the  organ?"  See  Analytical  R- 
view  for  Feb.  1797,  p.  139. 


Remarks  on  Abstinence.  337 

It  will  not,  I  conceive,  be  difficult  to  demon- 
strate that  abstinence  produces  effects  nearly  si- 
milar. That  emptiness  is  one  of  its  consequences, 
must  be  too  obvious  to  require  proof  or  illustra- 
tion— and  that  excitability  is  accumulated  by 
withdrawing,  for  a  time,  from  any  part  of  the 
living  body  its  accustomed  stimulus,  is  likewise 
a  fact  too  plain  and  simple  to  be  denied.  When 
food  and  drink  are  withheld,  no  person  will  doubt 
that  the  action  of  the  lacteal  and  lymphatic  absor- 
bents of  the  stomach  and  bowels  is  proportionably 
diminished ;  and  it  appears  to  be  a  law  of  the 
animal  economy,  that  any  diminution  of  the  ac- 
tion of  these  branches  of  the  absorbent  system 
will  be  compensated  by  a  correspondent  increase 
of  energy  in  the  cellular,  pulmonary,  cutaneous, 
and  other  absorbents.  Proofs  of  this  fact  might 
easily  be  multiplied.  The  effect  of  fasting  in 
exciting  a  very  copious  discharge  of  urine,  in 
dropsy,  exemplified  in  the  case  of  the  celebrated 
Dr.  Johnson,*  as  recorded  by  Sir  John  Hawkins, 
is  directly  in  point.  Dr.  Rush,  who  quotes  this 
case,  informs  us  he  has  tried  the  same  expe- 
dient, in  dropsies,  both  in  private  practice,  and 
in  the  Pennsylvania  Hospital,  and  found  a  confir- 
mation of  the  fact.f    With  respect  to  the  increase 

*  Life  of  Dr.  Johnson  by  Sir  John  Hawkins,  page  499, 
500. 

f  Med.  Inquiries  and  Observ.  vol.  ii,  p.  180. 
2u 


.338  Remarks  on  Abstinence. 

of  perspiration  by  abstinence,  it  would,  perhaps, 
be  more  correct  to  say,  that  it  prepares  the  way,  or 
rather  creates  a  disposition  in  the  secreting  ves- 
sels, on  the  surface  of  the  body,  to  be  more  pow- 
erfully acted  on  by  diaphoretic  medicines.     This 
class  of  medicines  are  all  said  to  exert  greater  ef- 
fect,  if  given  early  in  the  morning,  about  day- 
break,   than  at  any  other  time ;    and   this   must 
doubtless  be  ascribed  to  the  increased  excitability 
of  the  whole  system,   at  that  time,   accumulated 
during  sleep.     That  a  similar  accumulation    oi 
excitability  ensues  from  withholding  the  custom- 
.ii}'  stimulus  of  food,   cannot  be  called  in  ques- 
tion ;  and  it  is  equally  clear  that  this  accumulation 
is  especially  produced  in  the  secreting  vessels  of 
the  skin,  owing  to  the  well  known  sympathy  be- 
tween them  and  the  stomach.     It  follows  then 
that  any  diaphoretic  remedy,  and  even  very  gentle 
ones,   exhibited  in  this  condition  of  the  system, 
assisted   by  moderate  warmth,   will  act  with  in- 
creased energy,  and  this  augmentation  of  action 
will   be   commensurate   with    the  previous  aug- 
mentation of  excitability.     Every  one  must  have 
remarked  the  heat  and  glow  of  the  skin,  when  any 
stimulant  "matter   is   taken,    after   long   fasting; 
which  exactly  corresponds  with  a  glow  and  heat 
of  the  skin  immediately  succeeding  the  action  of 
vomiting. 

But,  however  useful  emetics  may  be  thought 


Remarks  on  Abstinence.  339 

at  the  approach  of  fevers,  they  are  liable  to  many 
exceptions.  Some  persons,  from  peculiarities  of 
conformation,  or  other  causes  not  well  understood, 
take  them  with  great  difficulty ;  in  many  condi  - 
tions  of  the  body  they  are  unsafe  ;  and  in  many 
cases  of  incipient  fever  their  operation  might  be 
followed  by  inconvenient  or  detrimental  conse- 
quences. 

Abstinence,  the  substitute  here  proposed,  is 
fitted  for  more  general  application,  and  possesses 
the  rare  advantage  of  being  adapted  to  obviate  the 
approach,  or,  at  least,  to  abate  the  violence,  of 
almost  all  acute  diseases.  The  safety  of  it  can 
scarcely  be  questioned  in  any  case.  If  an  in- 
flammatory disease  be  coming  on,  few  will  doubt 
the  propriety  of  total  abstinence  for  some  time, 
and  a  restriction  to  the  mildest  diet,  when  nou- 
rishment becomes  necessary.  To  fevers  which 
are  the  offspring  of  miasma  or  contagion,  this 
treatment  is  equally  applicable.  These  poisons, 
whatever  degree  of  similarity  or  variety  may  be 
attached  to  them  by  different  opinions,  are  gene- 
rally supposed  to  affect  the  system  by  a  stimulant 
operation,  and,  in  arranging  the  means  of  preven- 
tion, may,  at  all  events,  be  confidently  associated. 
There  seems  much  ground  to  suppose,  that  they 
ordinarily  obtain  introduction  by  the  mouth,  and, 
conveyed  by  the  saliva,  soon  find  a  lodgment  in 


J4U  Remarks  on  Abstinence. 

the  stomach.*  By  abstinence  that  organ  is  ena- 
bled to  maintain  a  more  vigorous  combat ;  to  rally 
all  its  forces ;  and,  finally,  by  dint  of  habit,  to 
disarm  the  noxious  intruder.  By  indulging  re- 
pletion at  such  a  moment,  by  heaping  alimenta- 
ry upon  morbid  stimulus,  the  energies  of  the 
stomach  must  be  in  hazard  of  being  overwhelmed, 
of  sinking  into  indirect  debility,  and  thereby  giv- 
ing deep  root  to  a  violent  disease.  Abstinence 
is  also  one  of  the  most  convenient  means  of  pre- 
venting diseases.  No  confinement  is  necessary, 
no  interference  with  the  ordinary  occupations  of 
life.  If  the  apprehensions  which  gave  rise  to  it 
prove  groundless,  no  trouble  nor  injury  is  sus- 
tained ;  but  the  system,  set  free  from  an  accus- 
tomed stimulus,  feels  a  lucid  interval,  not  often 
experienced  by  the  votaries  of  luxury,  and  after- 
wards returns  to  the  charge  with  redoubled  grati- 
fication. If  the  character  about  to  be  assumed 
by  the  disease  were  of  a  moderate  kind,  the  ab- 
stinence alone  we  suppose  to  be  sufficient  to 
strangle  it  in  the  birth  ;  if  more  malignant,  and 
our  easy  precaution  should  prove  insufficient, 
some  advantage,  and  not  a  trifling  one,  will  at 
least  have  been  gained.  The  stomach  will  cer- 
tainly be  in  a  better  condition  for  the  reception 
of  other  remedies. 

There  is  scarcely  any  disease  in  which  the  em- 
*  Gardiner's  Observations  on  the  Animal  Economy,  p.  196 


Remarks  on  Abstinence,  341 

ployment  of  abstinence  for  some  time,  and  after- 
wards of  a  mild,  cooling,  and  spare  diet,  is  so 
signally  beneficial  as  in  catarrh.  If  the  aid  of 
this  simple  treatment  were  not  so  much  neglected, 
we  should  not  so  often  see  catarrn  precipitated 
into  peripneumony,  or  protracted  in  phthisis.* 

To  relieve  the  debilitated  state  consequent  upon 
intoxication  with  vinous  and  spirituous  liquors, 
nothing  is  better  adapted  than  withholding  for 
some  time,  all  aliment.  This  remedy  is  the  more 
necessary,  as  acute  diseases  are  often  introduced 
on  occasions  of  intemperance,  and  a  malignant 
and  fatal  character  apparently  imparted  to  them 
from  this  cause.  In  cases  of  this  sort  particular- 
ly, and  probably  in  most  others,  where  abstinence 
is  recommended,  the  good  effects  of  it  will  be 
increased  by  frequent  draughts  of  cold  water,  and 
even  of  iced  water,  if  cautiously  used.  But  the 
cases  of  topical  inflammation  should  be  excepted 
in  this  observation. 

Chronical  vomitings  of  great  obstinacy  some- 
times occur,  in  which,  it  is  probable,  a  total  pro- 
hibition of  food  and  drinks,  for  some  time,  would 
afford  relief,  if  any  adequate  mode  of  nourishing 
the  body,  otherwise  than  by  the  stomach,  could 
be  devised.     Injections   and   baths  of  nutritive 

*  Medical  Observations  and  Inquiries,  vol.  iv?  p,  289. 


342  Remarks  on  Abstinence. 

fluids,  or  the  transfusion  of  blood  from  another 
animal  would  be  most  likely  to  answer  this  pur- 
pose. 

It  is  probable  that,  in  some  cases  of  fever,  the 
stomach  may  be  so  affected  by  the  virulence  of 
contagion,  as  to  become  completely  paralytic,  and 
unfit  for  the  reception  of  food  or  medicines.  In 
such  case,  every  thing  received  by  that  organ, 
if  not  pernicious,  must  be  entirely  useless  ;  and, 
perhaps,  the  best  means  of  restoring  its  power 
would  consist  in  leaving  it,  for  some  time,  in  a 
state  of  perfect  emptiness  and  quiet,  and,  mean- 
while, conveying  nutriment  and  remedies  into  the 
system  by  other  channels. 

In  diseases  of  great  direct  debility,  abstinence 
may  frequently  prove  an  excellent  remedy.  The 
reduction  of  excitement  in  the  stomach,  far  be- 
low the  natural  standard,  may  often  be  necessary, 
in  order  to  prepare  for  the  invigorating  operation 
of  succeeding  stimuli,  which  the  extensive  sympa- 
thies of  that  organ  are  so  well  calculated  to  pro- 
pagate over  the  whole  system. 

Two  cautions  will  obviously  occur  in  the  em- 
ployment of  this  regimen — first,  that  constitutions 
of  uncommon  feebleness  and  delicacy,  or  such  as 
are  broken  by  intemperance,  or  the  decline  of 
life,   can  safely  sustain  it  only  in  a  moderate  de- 


Remarks  on  Abstinence.  343 

giee — and,  secondly,  that  it  be  not  allowed  in  the 
case  of  violent  diseases,  to  usurp  the  place,  and 
lead  to  the  neglect  or  postponement  of  more  ac- 
tive remedies.  The  approach  of  fevers  may  be 
accompanied  with  such  signs  of  malignity,  or  the 
nature  of  the  prevailing  epidemic  may  suggest 
such  well-founded  distrust  of  any  apparent  mild- 
ness of  invasion,  as  to  render  abstinence  alone  too 
weak,  too  dilatory,  and  too  uncertain,  for  a  mo- 
ment of  such  urgency.  Still,  however,  it  may 
be  maintained,  that  all  other  remedies  will  derive 
additional  force  and  efficacy  from  the  co-operation 
of  this. 

Amongst  all  the  effects  of  emetics  and  absti- 
nence, at  the  approach  of  malignant  fevers,  none 
deserves  more  attention  than  the  increased  quan- 
tity of  excitability  which  they  collect.  The  doc- 
trine of  the  effects  of  stimulant  powers,  applied 
to  accumulated  excitability,  is  so  luminous  and 
philosophic,  rests  upon  so  broad  a  basis,  and  is 
of  such  important  and  extensive  application,  in 
the  conditions  both  of  health  and  disease,  that  it 
can  scarcely  receive  too  much  consideration. 
Proofs  and  examples  of  this  law  of  animal  nature 
are  continually  before  our  eyes.  We  observe  it 
in  the  effects  of  the  cold  bath — our  eyes  expe- 
rience it  in  passing  from  a  dark  apartment  to 
light — and  still  more  violently  in  the  effects  of  too 
much  food  or  warmth  allowed  to  persons  previ- 


344  Remarks  on  Abstinence. 

ously  subjected  to  famine  or  frost.  Diseases  also 
furnish  us  with  familiar  examples  of  the  same 
law,  in  the  powerful  effects  of  the  Peruvian  bark, 
after  the  previous  exhibition  of  emetics,  and  the 
redoubled  efficacy  of  opium  in  relieving  pain, 
when  it  has  been  preceded  by  venesection  and  a 
cathartic. 

On  this  grand  principle  it  is  easy  to  perceive 
to  what  extent,  and  in  what  various  degrees,  ab- 
stinence may  be  employed  as  a  preventative  and 
a  remedy.  In  the  first  place,  it  will  diminish  ex- 
citement, and  so  far  lessen  the  amount  of  stimu- 
lant power,  upon  which  the  attack  of  febrile- 
diseases  so  universally  depends  ;  and,  secondly, 
by  means  of  the  excitability  thus  collected,  the 
foundation  will  be  laid  for  a  more  effective  and 
vigorous  excitement  afterwards,  when  it  shall  be 
found  consistent  with  safety.  At  the  approach  of 
an  acute  disease,  the  abstraction  of  a  few  meals 
may  thus  either  repel  it  altogether,  or  greatly 
abridge  its  violence ;  and  when  that  is  accom- 
plished, the  renovated  stimulus  of  aliment,  so 
congenial  and  salutary,  will  be  sufficient  to  com- 
plete the  cure.  Common  articles  of  diet  are  thus 
rendered  active  remedies.  Powerful  medicines, 
in  too  large  doses,  or  unseasonably  exhibited,  are 
converted  into  poisons.  Just  so  with  respect 
to  the  mildest  aliment :  a  certain  condition  of  the 
system,  viz.  the  fasting  condition,  changes  it  into 


Remarks  on  Abstinence.  345 

an  active  stimulus  ;  and  another,  viz.  the  starving 
condition,  exalts  the  ordinary  quantities  of  food 
to  a  deadly  poison.  Arsenic  does  not  more  cer- 
tainly induce  fatal  inflammation  and  gangrene  in 
the  stomach,  than  mild  food,  taken  by  a  famishing 
person,  in  quantity  disproportionate  to  the  col- 
lected excitability.  Stimulants  may  not  only  be 
suited  to  the  state  of  the  system,  but  the  system 
itself  may  be  adapted,  in  this  manner,  to  the  force 
of  stimulants.  Such  a  remedy,  therefore,  as  ab- 
stinence, possessing  so  great  a  range  of  power, 
so  simple  and  so  accommodating,  if  it  be  not  al- 
lowed to  supersede  many  others,  certainly  cannot 
be  despised. 

If  the  art  of  preserving  health,  and  prolonging 
life,  chiefly  consist  in  a  frugal  and  sparing  use  of 
stimuli,  and  adapting  them,  with  caution  and  skill, 
to  the  fluctuating  circumstances  of  the  vital  prin- 
ciple, we  shall  surely  find  still  stronger  motives 
to  apply  this  doctrine  at  the  approach  and  in  the 
treatment  of  diseases,  when  noxious  powers  of 
such  preternatural  violence  invade  the  body,  baffle 
every  remedy,  and  stimulate  it  to  death.  The 
regulation  of  this  vital  principle,  here  denominated 
excitability,  the  preservation  of  it  when  present, 
and  the  restoration  of  it  when  deficient,  the  re- 
straint of  excitement  within  the  bounds  of  mo- 
deration, the  prohibition  of  all  wasteful  and  under- 
mining excesses,  will  probably,  hereafter,  at  some 

2  x 


346  Remarks  on  Abstinence, 

more  enlightened  asra  of  medicine,  form  a  system 
of  rules  for  the  management  of  health,  and  the 
prevention  of  diseases,  for  the  enjoyments  of  sense, 
and  the  refinement  of  intellect,  which,  instead  of 
the  present  feverish  dream  of  human  life,  will 
present  a  consummation  of  improvement  and 
happiness,  which  we  now  ascribe  to  superior 
beings. 

I  have  thus  undertaken  to  examine  a  noted  po- 
pular observation,  to  inquire  into  its  truth,  and  to 
demonstrate  its  consistency   with  the  most  esta- 
blished principles  of  the  animal  economy.    If  I  do 
not  mistake,  it  has  been  proved  that  abstinence 
will  be  often  a  complete,  generally  an  useful,  and 
almost  always  a  safe  means  of  obviating  the  ap- 
proach of  acute  diseases.     And,  in  a  word,   if  it 
were  possible  to  offer  to  mankind  a  maxim  of 
universal  application  to  the  treatment  of  incipient 
fevers,    in  all  their  variations  and  circumstances, 
I  should  be  inclined  to  hazard  the  following  apho- 
rism :    When  symptoms,  denoting  the  approach  of 
acute  diseases,  are  discovered,  abstain,  for  a  pro- 
per length  of  time,  from  all  aliment. 


OBSERVATIONS 


PHENOMENA,   CAUSES,  AND  TREATMENT 


OF 


SEA-SICKNESS. 


so 
DAVID  RAMSAY,  M.  D.  &c. 

CHARLESTON,  SOUTH  CAROLINA. 


Dear  Sir, 

YOUR  friendly  correspondence  with  the 
author  of  the  following  pages ;  Your  repeated  ap- 
probation of  his  literary  labours  ;  Your  patronage 
of  the  medical  work  of  which  he  was  so  long  one 
of  the  Editors ;  and  especially  Your  own  large 
and  honourable  additions  to  the  literature  and 
science  of  our  Country,  have  forcibly  directed  my 
views  to  You,  as  one  of  the  Patrons  of  the  pre- 
sent volume.  Allow  me,  therefore,  with  senti- 
ments of  the  highest  respect,  to  prefix  Your 
Name  to  the  Essays  which  close  the  collection. 

May  the  period  be  distant  which  shall  add  You 
to  the  list  of  those  Masters  of  the  Healing 
Art,  who  have  found  that  art  unavailing  when 
"  their  days  were  numbered  !"  and  when  it  shall 
arrive,  may  it  find  you  prepared  for  that  Kingdom 
where  disease  and  death  shall  be  forever  unknown  ! 
I  have  the  honour  to  be,  Sir, 
Your  obedient  servant, 

THE  EDITOR. 


Princeton,  N.  J.  ~) 
April  6,  1814.  5 


OBSERVATIONS,  &c 


JL  HIS  disease  affects  most  persons  on  their  first 
going  to  sea.  It  is  of  various  degree  and  duration 
in  different  instances ;  frequently  slight  and  tran- 
sient; sometimes  severe,  protracted,  and  excru- 
ciating. In  general,  it  continues  only  for  the  first 
day  or  two  of  a  voyage,  produces  little  trouble  or 
confinement,  and  is  attended  with  no  danger.  In 
a  few  cases  it  begins  at  the  first  moment  of  em- 
barkation, harasses  the  patient  with  incessant 
tortures  for  weeks  and  months,  or,  at  least,  recurs 
with  violence  at  every  return  of  bad  weather, 
and  only  releases  him  from  his  sufferings  at  the 
end  of  the  voyage.  It  has  likewise  happened,  on 
some  occasions,  that  the  symptoms  of  sea- sick- 
ness have  not  disappeared  even  on  the  arrival  of 


352  Observations  on  Sea-  Sickness. 

the  vessel  in  port,  and  the  patients  going  ashore. 
And  examples  have  not  been  wanting  of  such 
derangement  of  the  system,  by  the  violence  and 
obstinacy  of  this  disease,  as  gradually  to  induce 
fever  of  the  worst  kind,  attended  with  loss  of  all 
retentive  power  of  the  stomach,  and  terminating 
in  death. 

Sea- sickness  is  more  apt  to  occur  in  the  open 
sea,  where  the  waves  have  an  extensive  and  unin- 
terrupted course  of  motion,  than  in  gulfs,  bays, 
channels  and  rivers.  It  is  chiefly  troublesome 
when  the  sea  is  much  agitated  by  wind.  The 
vibrating  motion  of  a  vessel,  from  stem  to  stern, 
and  from  stern  to  stem,  which  is  called  pitching, 
or  that  from  one  side  to  another,  called  rolling,  pro- 
duces the  severest  degrees  of  giddiness  and  sick- 
ness. These  motions  are  observed  when  the 
vessel  is  going  directly  before  the  wind,  or  when 
a  calm  suddenly  succeeds  a  storm,  and  not  when 
the  wind  blows  obliquely,  or  on  the  quarter,  for 
then  the  succussion  which  the  ship  undergoes  is 
much  diminished. 

In  small  vessels,  on  which  the  slightest  move- 
ment of  the  waves  make  an  impression,  this  dis- 
order is  more  likely  to  take  place  than  in  very 
large  ones,  such  as  ships  of  war,  or  merchantmen 
of  great  burden,  deeply  laden,  which,  compara- 
tively,  undergo  little  disturbance.     It  has  been 


Observations  on  Sea- Sickness.  353 

also  observed,  that  where  habit  produces  accom- 
modation to  the  motions  of  one  vessel,  removal 
to  another,  whether  from  a  larger  to  a  smaller,  or 
from  a  smaller  to  a  larger,  will  sometimes  again 
awaken  the  disease. 

Aged  persons  are  seldom  affected  with  the  dis- 
ease, in  comparison  of  those  at  the  younger  and 
middle  periods  of  life.  Those  of  a  dark  com- 
plexion, in  general,  suffer  less  than  such  as  are 
fair :  and  infants  are  commonly  altogether  ex- 
empted. 

As  a  description  and  an  example  of  the  suf- 
ferings sometimes  endured  from  this  disease,  the 
following  account  is  given  by  a  medical  gentle- 
man, of  his  own  case,  in  the  voyage  of  the  em- 
bassy from  the  King  of  Great  Britain  to  the 
Emperor  of  China.  "  He  felt,"  he  said,  "  at 
first,  a  sickness  in  his  stomach,  followed  by  a 
retching,  when  he  threw  up  whatever  he  had  ta- 
ken into  it ;  then  green,  and  afterwards  yellow 
bile  ;  to  which  succeeded  a  thick,  mucilaginous, 
insipid  fluid,  which  he  considered  to  be  the  gas- 
tric juice ;  and,  lastly,  grumous  blood.  Before 
he  vomited  the  last,  he  felt  a  sensation  as  if  his 
stomach  were  twisting  together,  and  which  mo- 
tion, he  supposed,  produced  the  haemorrhage. 
Had  the  blood  proceeded  from  the  lungs,  he 
judged  it  would  have  been  spumous,  or  mixed 

2  v 


vjo4  Observations  on  Sea-  Sickness. 

with  air-bubbles  (and  florid.)  He  felt  constantly 
a  nausea  in  his  mouth ;  his  salivary  glands  swelled, 
and  the  saliva  became  thickened  and  vitiated. 
His  mind  grew  indifferent  to  all  things,  either 
past  or  future,  and  even  to  his  existence.  Re- 
gret and  hope  were  equally  extinct  within  his 
breast.  His  head  felt  light  and  sore,  and  as  if  its 
sutures  were  separated  from  each  other.  It  like- 
wise ached;  and  he  had  alternate  sensations  of 
violent  heat  and  chilling  cold.  He  thought  he 
felt  the  inversion  of  the  peristaltic  motion,  and  its 
actual  tendency  upwards  from  the  intestines  to 
the  mouth.  Whatever  he  swallowed  he  returned, 
with  no  alteration  of  it  in  the  stomach.  The 
bare  mention  of  food,  solid  or  liquid,  was  loath- 
some to  him."* 

CAUSES  OF  SEA-SICKNESS. 

Sea-sicknessf  begins  with  giddiness  and  ver- 
tigo, which  not  only  demand  attention  in  des- 
cribing the  order  of  the  symptoms,  but  likewise 
afford  a  clue  to  trace  the  nature  and  causes  of  the 

*  Staunton's  Account  of  Lord  Macartney's  Embassy  to 
China,  vol.  i,  p.  145  and  146. 

f  In  this  Inquiry  into  the  causes  of  sea-sickness,  I  have 
adopted  the  theory  of  Dr.  Darwin.     I  have  also  made  use  of 
several  of  his  facts  and  illustrations,  as  they  are  the  most  fa- 
miliar and  apposite  of  any  which  are  now  within  my  reach 
[See  Zoonomin,  vol.  i,  sect.  20 


Observations  on  Sea- Sickness.  355 

disease.  This  species  of  vertigo  originates  from 
disordered  action  of  the  organ  of  vision,  produced 
by  the  instability  and  unaccustomed  movements 
of  all  objects  upon  the  water.  That  such  is  the 
cause  of  it,  is  proved  from  its  being  excited  in 
some  people,  though  in  a  less  degree,  by  gazing 
on  the  fluctuations  of  a  river  (provided  no  fixed 
objects  appear  within  the  sphere  of  distinct  vi- 
sion,) or  by  the  sight  of  a  large  revolving  wheel, 
while  the  vertiginous  persons  themselves  are  per- 
fectly at  rest,  and,  by  shutting  their  eyes,  can 
instantly  arrest  this  troublesome  sensation.  Ano- 
ther proof  that  vertigo  may  arise  from  the  effects 
of  the  instability  and  indistinctness  of  visible 
objects  on  the  eyes,  is  derived  from  our  depen- 
dence upon  the  steadiness  of  such  objects  in 
walking  and  in  balancing  the  body.  We  con- 
stantly determine  the  distances  of  the  objects 
which  we  approach  by  our  eyes,  and,  by  observ- 
ing their  perpendicularity,  regulate  our  own : 
hence  no  one  who  is  hoodwinked  can  walk  in  a 
straight  line  for  an  hundred  steps  together.  And 
when  children  are  learning  to  walk,  it  is  easy  to 
observe  the  efforts  they  make  to  adjust  their 
perpendicularity  by  surrounding  objects,  and  how 
instantaneously  they  fall,  when  either  their  atten- 
tion is  unexpectedly  called  oft*  from  this  adjust- 
ment, or  when  an  object  which  had  caught  their 
eyes,  and  had  been  hitherto  stationary,  is  made 
to  undulate.     This  power  of  balancing  the  body 


o56  Observations  on  Sea- Sickness. 

by  the  view  of  surrounding  objects  is  acquired 
with  difficulty,  maintained  solely  by  habit,  and 
may  be  readily  impaired  or  destroyed  by  disuse  ; 
for  persons  who  have  been  long  confined  to  bed 
are  found  to  reel  and  stagger  in  their  first  at- 
tempts to  walk,  and  only  by  patient  endeavours 
recover  their  former  steadiness.  The  principle 
of  our  dependence  upon  vision  in  balancing  the 
body  by  external  objects,  and  of  the  tendency  to 
vertigo,  whenever  that  sense  is  impaired  by  dis- 
turbance or  disease,  is  still  further  illustrated  by 
the  vertiginous  sensations  which  often  affect  el- 
derly persons  when  they  begin  to  suffer  dimness 
of  sight,  and  which  are  frequently  relieved  by  the 
use  of  spectacles,  or,  at  length,  by  acquiring  the 
habit  of  adjusting  perpendicularity  by  objects  less 
distinctly  seen. 

That  distinctness  of  visible  objects  which  is 
requisite  to  the  balancing  of  the  body  with  stea- 
diness, and  to  the  prevention  of  vertigo,  may  be 
diminished  or  destroyed  in  various  ways,  all  of 
which  seem  to  throw  light  upon  this  subject. 
Objects  may  become  indistinct,  1st,  by  reason 
of  their  smallness  and  similarity  to  one  another. 
Many  persons  become  dizzy  in  a  room  hung  with 
paper  coloured  with  small  and  similar  figures, 
where  the  eyes  do  not  readily  find  a  resting  place, 
nor  distinguish  their  movements  in  continually 
passing  from  one  figure  to  another.     But  by  af- 


Observations  on  Sea- Sickness.  357 

fixing  to  the  wall  a  sheet  of  white  paper,  or  by 
drawing  figures  of  a  larger  or  more  diversified 
size,  the  giddiness  becomes  no  longer  perceptible. 
It  is  for  the  same  reason  that  vertigo  is  produced, 
in  some,  by  passing  over  a  plain  covered  with 
snow,  without  trees  or  other   eminent   objects. 

2.  Objects  become  indistinct,  and  the  beholder 
vertiginous,  on  account  of  their  distance,  and  the 
direction  in  which  they  are  seen.  It  is  for  this 
reason  that  many  become  giddy  in  ascending  lofty 
heights,  or  in  looking  down  a  deep  precipice. 
Objects,  placed  at  such  a  distance,  are  beyond  the 
sphere  of  distinct  vision,  and,  therefore,  unsuita- 
ble to  regulate  our  perpendicularity.  The  debili- 
tating impression  of  fear  must  likewise  be  admit- 
ted, in  this  case,  to  produce  a  share  of  the  effect. 

3.  The  distinctness  of  objects  is  lost,  and  giddi- 
ness produced,  by  their  unusual  and  excessive  mo- 
tions. Instances  of  this  sort  are  very  numerous, 
such  as  the  view  of  a  great  cataract,  of  a  large  re- 
volving wheel,  &c.  the  first  attempts  to  ride  on 
horseback,  to  mount  a  camel,  an  elephant,  &c. 
riding  backwards  in  a  coach,  swinging,  riding  in 
a  sleigh,  skating,  turning  swiftly  round  on  one 
foot,  and  more  especially  in  the  disease  now  under 
consideration. 

The  effect  of  these  motions  upon  the  organ  of 
sight  is  also  much  increased  by  the  ocular  spectra 
of  objects  remaining  some  time  upon  the  retina, 


358  Observations  on  Sea- Sickness. 

thereby  exceedingly  augmenting  the  disturbance 
of  the  eyes,  and  adding  to  the  confusion  of  the 
vertiginous  person.  When  any  one  turns  rapidly 
round  till  he  becomes  giddy,  and  falls  upon  the 
ground,  the  spectra  of  circumambient  objects  con- 
tinue to  present  themselves  in  rotation,  and  he 
seems  to  behold  such  objects  still  in  motion. 
These  spectra  appear  to  be  a  continuation  of  the 
motions  of  the  optic  nerve,  which  had  been  ex- 
cited by  the  objects  which  they  severally  repre- 
sent. They  are  apt  to  remain,  to  recur,  or  to  be 
prolonged,  in  proportion  to  the  degree  of  debility 
induced ;  hence  they  must  greatly  aggravate  the 
more  violent  cases  of  sea-sickness,  and  produce  an 
infinite  number  of  deceptions  of  the  sight  and  of 
imagination.  Their  effects  are  well  known  in  fe- 
vers of  debility,  by  producing  the  symptom  called 
muscoz  volitantes,  &c. 

Besides  the  vertigo  of  disordered  vision,  it  is 
probable  sea-sickness  is  generally  produced,  in 
part,  by  another  species — that  of  disordered  touch 
or  feeling — and  which  has  been  called  tangible 
vertigo.  When  a  blind  person  turns  round,  or 
when  one  who  is  not  blind  revolves  in  the  dark,  a 
vertigo  is  produced  belonging  to  the  sense  of 
touch  :  for  his  feet  now  touch  the  floor  in  manners 
or  directions  different  from  those  they  have  been 
accustomed  to ;  and,  in  consequence,  he  becomes 
bewildered  as  to  the  situation  of  his  body  in  rela- 


Observations  on  Sea- Sickness.  359 

lion  to  the  floor,  loses  his  perpendicularity,  and  is 
rendered  giddy.  This  combination  of  visual  and 
tangible  vertigo,  in  producing  the  phenomena  of 
sea- sickness,  seems  to  have  escaped  the  attention 
of  those  who  have  treated  of  this  disease.  Sailors 
remark,  that  such  persons  as  can  soonest  accommo- 
date themselves  to  the  ship's  motion,  and  acquire 
the  habit  of  standing  and  walking  uprightly,  with- 
out reeling  to  and  fro,  are  least  distressed  by  sea- 
sickness, and  most  speedily  recover.  The  insta- 
bility of  visible  objects,  and  the  reeling  induced 
in  the  beholder,  reciprocally  increase  one  another. 

Having  thus  mentioned  some  of  the  various 
modes  in  which  vertigo  may  be  produced  by  a 
disordered  and  excessive  action  of  the  organ  of 
vision  and  of  touch,  particularly  such  as  arise  from 
the  rotation,  undulation,  or  other  irregular  and  un- 
usual motions  of  external  objects,  as  well  as  of  the 
beholders,  I  am,  in  the  next  place,  to  show  in 
what  manner  vertigo  produces  the  nausea  and  vo- 
miting which  quickly  ensue. 

It  does  not  appear,  at  first  view,  how  nausea 
and  vomiting  proceed  from  a  disturbance  of  the 
action  of  the  visual  organ.  But  when  it  is  recol- 
lected that  violent  giddiness,  the  immediate  result 
of  such  disturbances,  precedes  and  occasions  these 
perversions  of  the  alimentary  canal,  the  difficulty 
vanishes.    Vertigo,  and  disorders  of  the  alimentary 


360  Observations  on  Sea- Sickness. 

canal,  reciprocally  produce  each  other.  Professor 
Gregory,  of  Edinburgh,  asserts  this  in  the  follow- 
ing words :  "  Vertiginem  nausea  solet  comitari, 
alter aque  alteram  inducer ■?."*  It  is  not  the  pre- 
sent object  to  inquire  into  all  the  species  and  vari- 
eties of  vertigo  which  may  be  found  enumerated 
in  systems  of  nosology  ;  but  whether  accompany- 
ing the  attack  of  apoplexy,  palsy,  epilepsy,  hyste- 
ria, or  syncope ;  whether  induced  by  injuries  of 
the  head  from  external  violence,  by  excessive 
evacuations,  or  at  the  accession  of  fevers,  it  is  ge- 
nerally attended  with  sickness  of  stomach.  And, 
on  the  other  hand,  when  the  alimentary  canal  is 
primarily  disordered,  as  in  cases  of  indigestion, 
taking  emetics,  drunkenness,  swallowing  of  poi- 
sons, gastritis,  enteritis,  &c.  vertigo  is  generally 
found  to  take  place.  Sea- sickness  is,  therefore, 
a  consequence  of  certain  sympathies,  or  associa- 
tions of  motions  of  different  parts  of  the  animal 
system.  And  there  is  ground  to  conclude,  that 
the  vomiting  caused  by  a  stone  in  the  bile-duct, 
or  in  the  ureter,  as  well  as  that  arising  from  in- 
flammation of  the  intestines,  or  at  the  accession  of 
fevers,  is  produced  in  a  similar  manner. 

If  it  be  admitted  that  certain  organs,  or  parts  of 
the  body,  become  associated  in  their  actions  (and 
the  proofs  of  such  an  association  continually  recur 

CoDspectne  Medicime  Theoretics;,  vol.  i,  p.  145. 


Observations  on  Sea- Sickness.  361 

in  observing  the  functions  of  the  animal  system,} 
it  will  follow,  that,  in  a  state  of  health,  each  organ, 
or  part,  in  this  associated  series  or  circle,  has  its 
appropriate  share  of  nervous  or  vital  power.     But 
if  one  of  these  organs  or  parts  be  subjected  to  vio- 
lent or  irregular  action,  as  such  action   consists 
in  the  employment  and  expenditure  of  nervous 
power,  the  balance  of  the  distribution  of  this  power 
must  be  disturbed,  and  while  one  part  expends 
too  much,  the  others  will  possess  too  little.     This 
is    obviously    illustrated   by  the    appearances  of 
drunkenness.     While  the  stomach  is  stimulated 
to  excess  by  fermented  or  distilled  liquors,  the 
muscles  of  voluntary  motion,    the  optic  nerves, 
&c.  are  deprived  of  their  share  of  nervous  influ- 
ence ;  and  hence  the  inebriate  becomes  vertigi- 
nous, and  his  limbs  refuse  their  accustomed  office. 
Just  so  it  is  with  persons  unaccustomed  to  the  mo- 
tions of  the  water,  when  they  go  on  shipboard. 
The  excessive,  irregular  and  unusual  actions  of  the 
organ  of  sight,  expend  a  disproportionate  share  of 
nervous  power,  and,   of  consequence,  the  parts 
connected  with  it  by  association  must  soon  suffer 
by  a  deprivation  of  their  proper  quantity.     The 
stomach,  which  possesses  more  extensive  and  in- 
timate relations  with  the  rest  of  the  system  than 
any  other  viscus,  will  be  the  first  to  feel,  and  after- 
wards to  propagate  this  morbid  impression  to  other 
parts  of  the  bodv. 


o62  Observations  on  Sea- Sickness. 

Attention  to  the  following  circumstances  will 
go  far  to  explain  the  seeming  disproportion  be- 
tween cause  and  effect,  in  this  mode  of  accounting 
for  the  violence  of  sea-sickness  in  persons  unac- 
customed to  the  incessant  agitation  of  the  ocean. 
1.  The  motion  is  not  only  unusual,  irregular  and 
complicated,  but  excessive.  The  movements  of 
the  waves,  forming  a  vast  expanse  of  surface,  agi- 
tated and  rolling  in  a  thousand  shapes — the  diver- 
sified movements  of  the  ship,  with  all  its  variety 
of  parts  and  appurtenances — and  the  movements 
of  the  voyager  himself  reeling  and  staggering  in 
every  direction :  all  these  form  an  aggregate  of 
agitation  sufficient  to  distract  the  steadiest  head. 
The  contrast  between  this  scene  and  such  as  are 
found  on  the  land,  where  a  great  majority  of  ob- 
jects are  either  at  rest,  or  moving  with  steadiness 
and  regularity,  must  be  apparent  to  all.  2.  The 
excessive  action  of  the  organ  of  sight,  produced 
by  this  aggregate  of  unusual  motion,  will  not  ap- 
pear strange,  if  the  quantity  of  nervous  power  ex- 
pended on  the  eyes  be  duly  considered.  No  part 
of  the  system,  in  proportion  to  bulk,  is  so  plenti- 
fully supplied  with  nerves  as  the  eyes.  Each  op- 
tic nerve  is  as  large  as  a  crow-quill  at  its  entrance 
into  the  eye.  Besides  these,  the  third,  fourth,  and 
sixth  pairs  of  nerves,  as  well  as  part  of  the  fifth 
pair,  belong  to  this  organ.  The  incessant  em- 
ployment and  activity  of  vision,  during  the  day, 
considered  in  connection  with  the  size  and  num- 


Observations  on  Sea- Sickness.  363 

ber  of  the  nerves  devoted  to  this  sense,  will  evince 
that  the  consumption  of  nervous  power  in  the  eyes 
is  fully  as  great,  if  not  greater,  than  that  bestowed 
upon  the  whole  of  the  upper  extremities.  3.  The 
intimate  sympathy  between  the  brain  and  the  sto- 
mach is  also  to  be  considered ;  whereby  the  dis- 
ordered actions  of  the  organ  of  vision,  which  pos- 
sesses so  large  a  branch  of  the  nervous  system, 
make  an  immediate  and  powerful  impression  on 
the  stomach,  invert  its  motions,  cause  profuse 
discharges  of  bile,  &c.  and  produce  all  the  train 
of  distressing  sensations  which  belong  to  sea- 
sickness. 

It  is  surprising  to  observe  what  slight  causes 
will,  in  some  constitutions,  produce  vertigo.  An 
unusual  posture,  an  inconsiderable  elevation  from 
the  ground,  and  even  a  momentary  view  of  objects 
moving  so  as  to  attract  the  gaze  of  beholders,  will 
sometimes  excite  this  sensation.  Small  modifica- 
tions of  motion  will  also  serve  to  relieve,  as  well 
as  to  produce  it.  A  lady  informed  me,  that,  after 
constantly  suffering  nausea  for  some  time,  from 
riding  in  a  sleigh,  she  was  relieved,  in  the  latter 
part  of  the  journey,  by  a  more  harsh  and  rugged 
motion,  in  consequence  of  the  snow  suddenry 
dissolving,  and  leaving  the  earth  bare.  In  this 
case,  it  is  probable  that  the  smooth  and  almost 
imperceptible  progress  of  the  sleigh,  while  gliding 
over  the  snow,  prevented  the  lady's  distinguish^ 


364  Observations  on  Sea- Sickness. 

ing  the  apparent  motions  of  objects  which  were 
absolutely  at  rest,  from  the  real  motions  of  them ; 
and  this  confusion  seems  to  have  been,  at  least  in 
part,  the  cause  of  her  giddiness  and  nausea.  The 
course  of  the  sleigh  over  sand,  gravel,  &c.  was  a 
nearer  approach  to  ordinary  habits  of  motion. 

It  is  fortunate  for  such  as  are  destined  to  a  sea- 
faring life,  and  to  other  employments  which  are 
apt  to  produce  similar  giddiness  and  nausea,  that 
these  affections  are  commonly  of  short  duration. 
The  dominion  of  habit,  in  these  cases,  is  extreme- 
ly favourable.  The  Dervises  of  Turkey,  who 
practise  the  motion  of  turning  themselves  swiftly 
round  as  a  ceremony  of  religion,  soon  learn  to 
perform  it  without  giddiness.  A  similar  habit  is 
acquired  among  the  Shakers,  a  fanatical  sect  of 
religionists  in  the  State  of  New- York.  My  col- 
league, Dr.  Mitchill,  informs  me,  that  he  saw  a 
female  of  that  sect  turning  herself  round  about 
sixty  times  in  a  minute,  for  the  space  of  five  mi- 
nutes, without  interruption ;  and  this  was  done 
without  any  appearance  of  her  becoming  vertigi- 
nous. 

A  question  naturally  arises  on  this  subject,  why 
some  persons  are  more  liable  than  others  to  verti- 
go and  nausea,  in  consequence  of  unaccustomed 
motions  ?  This  is  the  result  of  a  greater  prompt- 
itude, in  some  constitutions,   to  run  into  sympa- 


Observations  on  Sea- Sickness.  365 

thetic  or  associate  actions.  It  is  not  easy  to  as- 
sign the  reason  why  movements  of  the  animal  sys- 
tem, which  have  once  occurred  in  succession  or 
combination,  should  afterwards  acquire  a  tenden- 
cy habitually  to  succeed  or  accompany  each  other. 
It  is  a  property  of  animated  nature,  and  distin- 
guishes this  department  of  being  from  others. 
There  seems  to  be  a  peculiar  temperament,  con- 
sisting in  the  too  great  facility  with  which  fibrous 
motions  acquire  habits  of  association,  and  in  the 
strength  with  which  these  associations  are  main- 
tained. In  constitutions  of  this  sort,  sympathy 
;icts  with  more  certainty  and  energy,  and  to  much 
greater  extent,  than  in  others.  And  it  is  proba- 
ble that  such  persons  are  much  more  liable  than 
common  to  all  the  class  of  sympathetic  diseases. 
For  example,  it  might  be  expected  that  such 
would  be  peculiarly  disposed  to  the  attack  of  in- 
termittent fevers  ;  that  the  periodical  return  of 
paroxysms,  in  these  cases,  would  be  more  diffi- 
cult to  arrest ;  and  that  they  would  be  liable  to 
recur,  from  slight  causes,  for  many  weeks  after 
they  had  appeared  to  be  cured.  The  force  of 
memory  seems  also  to  depend  upon  the  possession 
of  this  temperament ;  for  memory  is  understood 
to  mean  facility  and  strength  in  forming  and  retain- 
ing associations.  It  would  be  matter  of  curiosity 
to  ascertain,  whether  persons  of  retentive  memo- 
ry are  more  liable  to  fevers,  to  sea -sickness,  and 
to  all  the  various  diseases  of  association,  than 
others. 


366  Observations  on  Sea- Sickness. 


TREATMENT  OF   SEA-SICKNESS. 

Having  thus  endeavoured  to  describe  the  ap- 
pearance of  sea-sickness,  and  to  assign  the  more 
probable  causes,  I  proceed,  in  the  next  place,  to 
the  treatment  of  the  disease. 

Much  may  certainly  be  done  towards  the  pre- 
vention of  this  disorder.  It  has  been  proposed, 
that  persons  intending  to  go  to  sea  should,  for 
some  time  previously,  accustom  themselves  to 
swinging,  or  to  some  other  unusual  motions 
adapted  to  induce  giddiness.  The  exercise  of 
turning  round  upon  one  foot  would  probably  an- 
swer this  purpose  as  well ;  and  it  may  be  acquir- 
ed, after  some  practice,  so  as  to  be  performed  en- 
tirely without  vertigo. 

Sea-sickness,  like  many  other  diseases  of  asso- 
ciation, is  greatly  under  the  dominion  of  emotions 
and  passions  of  the  mind.  By  forcibly  directing 
the  attention  to  a  particular  object,  the  nausea 
may  be  relieved,  at  least  for  a  short  time.  By 
joyful  or  alarming  news,  by  the  terrors  of  a  storm 
or  of  shipwreck,  by  the  prospect  of  battle,  and  by 
violent  pain,  such  as  the  anguish  of  a  broken  or 
dislocated  bone,  the  disease  may  be  instantly  ar- 
rested. But  as  such  degrees  of  emotion  and  pain 
cannot  safelv  be  excited  on  manv  occasions,  and 


Observations  on  Sea- Sickness.  367 

are  not  susceptible  of  measure  or  regulation,  they 
are  obviously  unfit  for  practical  purposes. 

It  has  been  asserted,  that  keeping  the  eyes  shut 
or  covered,  if  begun  immediately  upon  embarka- 
tion, will  prevent  sea-sickness.  According  to  the 
principles  maintained  in  this  paper,  such  an  expe- 
dient cannot  be  without  use.  In  a  short  passage 
particularly,  lying  horizontally,  sitting  or  standing, 
so  as  to  be  firmly  and  steadily  supported  in  one 
position,  with  the  eyes,  for  the  most  part,  shut,  is 
by  no  means  impracticable,  and  deserves  to  be 
strongly  recommended.  I  am  informed,  by  a 
gentleman  of  observation,  that,  while  at  sea,  he 
enjoyed  almost  total  exemption  from  this  com- 
plaint during  the  darkness  of  the  night,  and  while 
he  lay  horizontally,  with  his  eyes  closed,  but  al- 
ways experienced  a  return  of  it  the  next  morn- 
ing, as  soon  as  he  arose,  and  began  to  look  at  sur- 
rounding objects.  All  agree  that  it  is  proper  to 
avoid  watching  or  gazing  at  the  waves,  especially 
when  they  are  strongly  agitated  by  tempest. 

The  proper  management  of  diet  will  do  much 
both  in  the  prevention  and  cure  of  this  disease. 
It  is  advised  to  eat  moderately  and  frequently,  to 
avoid  every  thing  calculated  to  produce  indiges- 
tion, and  to  select  such  articles  as  the  stomach  can 
digest  with  the  greatest  ease,  expedition  and  cer- 
tainty.    For  this  purpose   mariners  recommend 


368  Observations  on  Sea- Sickness. 

bread  and  fresh  meat  to  be  eaten  cold  with  pep- 
per ;  but  the  occasional  use  of  salted  meats  will 
not  be  found  hurtful,  and  sometimes  they  un- 
doubtedly deserve  a  preference.  Some  contend, 
that  keeping  the  stomach  constantly  full,  by  eat- 
ing biscuit,  &c.  is  one  of  the  best  preventives  ; 
and  it  is  not  improbable  that  the  stimulus  of  nu- 
tritious and  well- adapted  food,  combined  with  the 
stimulus  of  distention,  may  be  so  adjusted  as 
greatly  to  fortify  the  powers  of  the  stomach.  For 
drink,  it  is  recommended  to  use  liquids  impregnat- 
ed with  the  vegetable  or  carbonic  acids — such  as 
lemonade,  seltzer-water,  sound  malt  liquors,  ci- 
der, champaign,  &c. 

The  sea- sick  are  advised  to  keep  much  upon 
deck,  even  in  all  varieties  of  the  weather.  It  is 
also  enjoined  upon  them  to  take  brisk  exercise, 
such  as  assisting  at  the  pumps,  or  any  other  active 
employment,  with  as  little  intermission  as  the  na- 
ture of  the  case  will  allow  :  for  it  has  been  gene- 
rally remarked,  that  indolent  and  slothful  passen- 
gers are  most  apt  to  suffer  from  this  complaint. 
Governor  Winthrop^  in  his  Journal,  mentions  the 
efficacy  of  exercise,  on  a  voyage,  as  a  remedy  for 
sea- sickness,  in  the  following  terms  :  "  Our  chil- 
dren and  others  that  were  sick,  and  lay  groaning  in 
the  cabins,  were  fetched  out ;  and,  having  stretch- 
ed a  rope  from  the  steerage  to  the  mainmast,  we 
made  them  stand,  some  on  one  side  and  some  on 


Observations  on  Sea- Sickness-  369 

the  other,  and  swing  it  up  and  down  till  they  were 
weary,  and  by  this  means  they  soon  grew  well  and 
merry."* 

As  sea- sickness  is  undoubtedly  a  disease  of  as- 
sociation, and,  in  that  respect,  akin  to  the  nature 
of  fevers,  it  is  probable  that  the  stimulant  and  in- 
vigorating remedies  employed  to  repel  the  attack, 
as  well  as  to  prevent  the  recurrence  of  the  parox- 
ysms, of  intermittent  fevers,  might  also  be  suc- 
cessful in  guarding  the  stomach  against  the  inva- 
sion of  this  complaint.  The  Peruvian  bark  and 
other  bitters  would  be  likely  to  answer  this  pur- 
pose. And  after  the  actual  attack  of  the  disease, 
if  great  prostration  of  strength  and  exhaustion  en- 
sue, these  remedies,  combined  with  wine  and  opi- 
um, as  in  fevers  of  debility,  should  be  assiduously 
used. 

Preserving  regularity  of  the  intestinal  discharges, 
and  occasionally  exciting  some  degree  of  artificial 
diarrhcea,  will  form  an  important  part  Oi  the  treat- 
ment. The  aloetic  preparations  are  among  the 
most  suitable  of  the  cathartic  class.  If  acidity 
be  troublesome,  as  often  happens  to  the  feeble 
and  dyspeptic,  magnesia  will  become  necessary. 
Injections  of  sea- water  and  soap  are  always  conve- 
nient, and  deserve  to  be  very  frequently  employed. 

*  Winthrop's  Journal  of  the  Transactions  and  Occurrenc- 
es in  the  Settlement  of  Massachusetts,  &.c.  page  6. 

3    A 


370         Observations  on  Sea- Sickness. 

It  is  probable  the  injection  of  cold  water,  or  iced 
Avater,  which,  according  to  Monsieur  Pomme,  so  in- 
stantaneously relieves  the  inverted  motions  of"  the 
alimentary  canal  in  hysteria,  would  likewise  prove 
an  efficacious  remedy  in  this  case.  (See  Pommc 
Des  Affections  Vaporeuses,  p.  25.) 

As  the  stomach  and  skin  are  very  strongly  asso- 
ciated, the  former  may  be  often  excited  into  ac- 
tion, and  supported,  through  the  medium  of  the 
latter.  For  this  purpose  the  sea-sick  may  use  the 
warm  bath  alone,  or  alternated  with  cold  bath,  fric- 
tion of  the  skin  with  oil  and  camphor,  or  dry,  with 
powder  of  mustard  :  to  the  epigastric  region  they 
may  apply  plasters,  epithems  or  cataplasms  charg- 
ed with  aromatics  and  opium,  and,  in  severe  cases, 
sinapisms  or  blisters. 

Compression  of  the  abdomen,  by  means  of  a 
bandage  or  handkerchief,  is  recommended  by  sea- 
men, and,  there  is  reason  to  suppose,  on  good 
grounds.  The  savages  of  North- America,  When 
restricted  to  scanty  food,  and  pressed  by  hunger, 
fasten  a  belt  round  their  bodies  :  by  this  they  give 
support  to  the  empty  and  enfeebled  stomach,  and 
thereby  provide  a  substitute  for  the  stimulus  and 
distention  of  food.  When  the  stomach  has  been 
long  harassed  with  the  retchings  of  sea-sickness, 
this  mechanical  aid  will  assist  in  sustaining  the 


Observations  on  Sea- Sickness.  371 

system  until  it  becomes  habituated  to  its  new  sit- 
uation. 

It  will  seldom  be  requisite  to  combine  many  of 
these  remedies  in  the  treatment  of  a  single  case. 
For  the  most  part,  relief  is  easily  and  speedily  ob- 
tained, and  the  common  method  may  be  delivered 
in  a  few  words  :  When  nausea  comes  on,  and  can- 
not be  subdued  by  mental  exertion,  the  patient 
should  place  himself  in  a  horizontal  position,  shut 
his  eyes,  and  lie  perfectly  still.  If  vomiting  suc- 
ceed, he  should  take  some  draughts  of  an  infusion 
of  chamomile,  peppermint  or  ginger,  or  something 
similar.  Sea-water  is  commonly  recommended 
by  mariners.  When  the  stomach  has  been 
thoroughly  emptied  by  the  assistance  of  such 
drinks,  it  becomes  necessary  to  use  some  grateful 
stimulant.  I  am  informed,  that  on  board  of  the 
packet-boats  plying  between  the  British  ports  and 
those  of  the  adjacent  continent,  for  the  conveyance 
of  passengers,  that  spiced  wine  is  the  common 
remedy.  Where  this  fails,  recourse  may  be  had 
to  small  doses  of  sulphuric  (vitriolic)  ether,  fre- 
quently repeated,  till  it  compose  the  stomach. 
Small  doses  of  opiates  should  also  be  tried.  The 
effervescent  mixture  of  Riverius,  seltzer-water, 
lemonade  and  warm  punch,  will  succeed  in  some 
cases.  But  if  the  disease,  notwithstanding,  should 
obstinately  continue,  the  stomach  be  harassed  with 
incessant  retchings,  and  exhaustion  and  debility 


572  Observations  on  Sea- Sickness. 

take  place  to  an  alarming  degree,  it  will  be  requi- 
site to  adopt  the  treatment  usually  pursued  in  low 
fevers  of  debility.  Preparations  of  Peruvian  bark, 
or  rather  of  columbo  or  quassia,  with  wine  and  opi- 
ates, or  ether,  employed  in  rotation,  and  periodical- 
ly repeated,  so  as  to  sustain  a  moderate  and  equable 
excitement  of  the  stomach,  will  especially  claim 
attention.  And,  in  such  extreme  degrees  of  the 
disease,  the  other  remedies  above  mentioned  may 
likewise  be  selected  or  combined  in  such  manner 
as  to  suit  the  exigences  of  the  particular  case. 


It  is  often  necessary  to  attempt  the  cure  of  one 
disease  by  exciting  another.  With  this  view 
phthisical  patients  and  others  often  are  sent  to  sea. 
Instead  of  inquiring  into  all  the  circumstances  of  a 
sea- voyage  which  may  prove  beneficial  in  such 
diseases,  it  will  be  sufficient  for  the  present  pur- 
pose to  consider  the  affection  of  the  stomach  as  one 
of  the  chief  means  of  relief.  The  instances  of  the 
efficacy  of  this  remedy  are  too  numerous  and  re- 
markable to  admit  of  a  doubt.  But  it  has  hap- 
pened, in  many  cases  from  some  peculiarities  of 
the  stomach  or  constitution  generally,  that  the 
usual  nausea  and  vomiting  have  not  occurred,  or 
have  been  so  slight  and  transient  as  to  disappoint 
every  hope  of  advantage  from  the  voyage.  If  the 
efficacy  of  this  remedy  really  depend  upon  the  e  • 


Observations  on  Sea- Sickness.  373 

citement  of  nausea  and  vomiting,  it  is  much  to  be 
regretted  that  such  a  disappointment  should  take 
place  ;  as  it  seems  always  to  be  in  the  power  of  the 
voyager  to  increase  the  force  and  duration  of  the 
nausea,  by  artificial  means,  to  any  desirable  extent. 
Swinging,  in  one  form  or  another,  may  conveni- 
ently be  employed  in  aid  of  the  marine  vertigo. 
If  the  oscillating  or  pendulum-like  swing  should 
not  prove  sufficient  to  create  the  requisite  degree 
of  vertigo,  the  patient  might  be  whirled  in  a  chair 
suspended  from  aloft  by  two  parallel  cords  hang- 
ing near  to  each  other,  which,  after  being  circular- 
ly revolved  fifty  or  one  hundred  times  in  one  direc- 
tion, would  return  with  great  velocity  in  the  other. 
Or,  if  the  debility  of  the  patient  should  not  allow 
this  kind  of  motion,  a  small  bed,  affording  room 
to  lie  in  an  easy  position,  might  be  suspended  to  a 
simple  machine  adapted  to  whirl  it  with  any  pro- 
per degree  of  gentleness  or  velocity.  By  some  of 
these  means,  varied  in  such  manner  as  to  suit  the 
circumstances  of  each  particular  case,  there  can  be 
no  doubt  that  vertigo  might  be  increased  and  regu- 
lated at  pleasure. 

In  other  cases,  likewise,  besides  phthisis  pulmo- 
nalis,  the  marine  nausea  might  be  usefully  aug 
mented  by  additional  unaccustomed  motions. 
The  noted  example  of  its  efficacy,  mentioned  by 
Mr.  John  Hunter,  in  causing  the  matter  of  a  large 
bubo  to  be  unexpectedly  absorbed,  is  a  proof  of 


374  Observations  on  Sea- Sickness. 

great  power  in  promoting  the  action  of  the  lym- 
phatic vessels.  The  use  of  emetics,  in  chronic 
diseases,  might,  perhaps,  be  entirely  superseded 
by  sea-sickness,  properly  assisted  and  regulated 
by  some  of  the  other  means  of  exciting  vertigo. 


REMARKS 


ON  THE 


CHOLERA,  OR  BILIOUS  DIARRHCEA 


OF 


INFANTS. 


REMARKS,  &<■ 


r  v~ 1 

1  HE  cholera  of  infants  forms  one  branch  of  a 
large  stock  of  diseases,  as  much  distinguished  for 
the  universality  of  their  appearance,  as  for  the  di- 
versified character  they  occasionally  assume. 
Another  form  of  them,  more  familiarly  recognised 
by  the  public,  is  that  of  remittent  and  intermittent 
fevers.  On  account  of  circumstances,  which  eve- 
ry body  is  acquainted  with,  they  have  attracted, 
for  several  years  past,  much  more  attention  than 
usual.  Views  of  the  subject,  more  comprehen- 
sive and  accurate,  have  enlarged  the  number  of 
them,  by  bringing  back  to  their  proper  station 
many  diseases,  formerly  so  much  disguised  in  ex- 
ternal appearances,  as  to  conceal  the  fact  of  their 
radical  relation.     And  it  ^vill  not  be  surprising,  if 

3  B 


378       Remarks  on  the  Cholera  of  Infants, 

this  simplification  should  be  carried  much  farther ; 
nor  if  our  successors  should  group  together  a 
still  larger  assemblage  of  diseases,  and  demonstrate 
their  origin  from  one  common  cause. 

Notices  of  the  cholera  of  infants  are  to  be  found 
in  almost  all  the  writers  who  record  the  annual  epi- 
demics of  summer  and  autumn,  in  sickly  countries. 
Cleghorn,  in  his  account  of  the  diseases  of  Minor- 
ca, describes  it  exactly  as  it  appears  in  the  United 
States,  invading  children  some  weeks  sooner  in  the 
season  than  similar  affections  are  discovered  in 
adults  ;  which  he  properly  ascribes  to  their  great- 
er excitability,  and  to  the  remarkable  tenderness 
of  the  alimentary  canal  in  the  infantile  system. 

The  importance  of  the  subject  now  undertaken  is 
admitted  by  every  physician.  For,  notwithstand- 
ing the  nature  of  the  disease  is,  at  present,  well  un- 
derstood, and  the  treatment  greatly  improved,  it 
still  continues,  particularly  in  the  southern  and 
middle  States,  to  destroy  multitudes  of  infants, 
and  even,  in  more  favourable  cases,  to  prove,  in  a 
high  degree,  obstinate  and  distressing. 

An  interesting  account  of  the  cholera  of  infants, 
by  Dr.  Rush,  has  been  many  years  before  the  pub- 
He*     His  description  of  it  is  so  accurate,  that, 

Medical  Inquiries  and  Observations,  vol.  i,  p.  112. 


Remarks  on  the  Cholera  of  Infants.       379 

after  much  attention  to  the  disease,  I  am  unable  to 
add  any  thing  which,  in  that  respect,  deserves  to 
be  considered  as  important.  His  account  of  the 
nature  and  causes  of  this  complaint,  of  the  relation 
it  bears  to  some  others,  and  of  the  mistakes  that 
have  prevailed  on  this  point,  is  so  just,  that  it  has 
been  commonly  adopted.  The  mode  of  treatment 
he  recommends  is  very  judicious,  and  has  been 
generally  received.  But,  as  this  valuable  book  is 
in  the  hands  of  almost  all  our  medical  practition- 
ers, it  would  be  an  abuse  of  their  time  to  repeat 
these  things  here.  I  shall  not,  therefore,  attempt 
to  give  any  history  of  the  disease,  nor  propose  any 
general  plan  of  treatment,  or  any  minute  detail  of 
remedies.  My  observations  will  be  confined  to  a  few 
detached  points,  which  appear  to  me  to  be  impor- 
tant ;  and  they  will  be  often  so  irregular  and  de- 
sultory, that  this  paper  can  be  considered,  at  most,, 
only  as  a  brief  supplement  to  former  essays  on  the 
same  subject. 

The  physicians  of  the  United  States  seem  gen- 
erally to  concur  in  opinion,  that  a  retreat  from  an 
unhealthy  situation,  and  particularly  a  change 
from  the  air  of  cities  to  some  salutary  part  of  the 
adjacent  country,  is  one  of  the  best  means  both  to 
prevent  and  cure  this  disease.  The  evidence  in 
favour  of  this  opinion  is  such,  that  we  shall  take  it 
for  granted,  and  only  propose  the  application  of  the 


380       Remarks  on  the  Cholera  of  Infants, 

treatment  we  have   in  view  in  cases  where  the 
change  of  air  cannot  be  obtained. 

It  is  well  known,  that  the  situations  and  circum- 
stances of  a  large  proportion  of  the  community 
are  such,  as  necessarily  to  fix  them  in  the  spot 
where  they  happen  to  reside.  In  this  case,  the 
best  exertions  must  be  made  which  the  nature  of 
the  affair  will  admit. 

As  the  first  indication  which  presents  itself,  in 
the  treatment  of  this  disease,  is  to  discharge  the 
stomach  and  intestines  of  their  acrid  and  offensive 
contents,  great  difficulty  often  occurs  in  the  out- 
set, as  to  the  choice  of  the  means  to  effect  this  pur- 
pose. When  the  stomach  is  excited  into  action 
so  inverted,  convulsive  and  violent,  the  adminis- 
tration of  emetics  will  be  often  thought  hazardous. 
And  if  a  thorough  evacuation  of  the  offending  mat- 
ter shall  appear  to  have  been  already  accomplished 
by  spontaneous  vomiting,  or  if  the  disease  shall 
have  invaded  with  great  violence,  and  already  have 
produced  great  prostration  of  strength,  feebleness 
of  pulse,  and  a  receding  of  heat  from  the  extremi- 
ties, an  emetic  would  certainly  be  improper  and 
unsafe.  The  violent  action  of  the  stomach  should 
always  be  suffered  to  subside  before  such  a  remedy 
as  this  can  be  attempted  with  propriety. 

But  however  mischievous  the  rash  interposition 


Remarks  on  the  Cholera  of  Infants.       381 

of  this  remedy  may  often  prove,  the  maxim  that 
vomiting  should  never  be  employed  to  relieve 
vomiting,  has  been  sometimes  maintained  in  a 
sense  far  too  general  and  unqualified.  Mild 
emetics,  which  soon  cease  to  operate,  will  often 
leave  the  stomach  stronger  than  before.  This  is 
attributed,  by  Dr.  Darwin,  to  the  accumulation  of 
excitability  during  the  stomach's  inverted  action.* 
It  may  also,  perhaps,  be  in  part  ascribed  to  the  dif- 
ference in  the  modes  of  action,  which  take  place 
in  spontaneous  and  in  artificial  vomiting. 

To  relieve,  however,  any  doubt  on  this  subject, 
whenever  the  state  of  the  stomach  and  intestines  is 
found  to  require  evacuation,  a  more  safe  and  un- 
equivocal means  of  effecting  the  purpose,  it  is  con- 
ceived, may  be  found  in  the  use  of  calomel,  ac- 
commodated in  its  dose  to  the  age  of  the  patient, 
and  to  other  circumstances.  And  as  long  as  mere 
evacuation  can  be  requisite  or  admissible,  this 
medicine,  uncombined,  will  prove  efficacious,  gen- 
tle and  safe.  As  soon  as  the  profuseness  or  suffi- 
ciency of  the  discharges,  or  symptoms  of  debility, 
admonish  to  support  the  strength,  the  addition  of 
opium  to  the  calomel,  in  suitable  quantity  to  com- 
pose the  stomach  and  bowels,  forms,  in  my  judg- 
ment, one  of  the  most  powerful  remedies  ever  em- 
ployed in  this  disease. 

*  Zoonomia,  vol.  ii,  p.  57 


382         Remarks  on  the  Cholera  of  Infants. 

To  recommend  the  trial  of  mercury,  alone  or 
combined  with  opium,  as  different  states  and  exi- 
gencies of  this  disorder  may  require,  is  one  of  the 
principal  objects  of  this  paper.  A  case  of  infantile 
cholera,  very  violent  and  protracted,  attended  with 
dysenteric  symptoms,  first  induced  me  to  make 
trial  of  this  remedy,  according  to  Dr.  Clark's  plan 
of  treating  chronic  dysentery.*  It  succeeded  so 
completely,  that  I  soon  extended  the  use  of  it  to 
the  bilious  diarrhoea  of  children  ;  and  here  it  an- 
swered as  happily  as  before.  Some  of  my  medical 
friends  have  since  made  trial  of  it,  and,  they  assure 
me,  with  singular  advantage.  If  with  others  the 
same  benefit  should  result,  it  will  certainly  not  be 
thought  unworthy  of  being  recommended  to  the 
public  ;  and,  if  future  experience  should  find  me 
too  sanguine  in  my  estimation  of  this  medicine, 
this  brief  paper  will,  at  most,  add  but  little  to  the 
mass  of  hasty  and  injudicious  encomiums  bestow- 
ed  on  favourite  remedies. 

As  to  the  dose  of  this  medicine,  or  the  interval 
of  repetition,  it  is  difficult  to  speak  with  precision, 
considering  the  variety  of  circumstances  which 
must  always  determine  questions  of  that  sort.  It 
will,  perhaps,  convey  an  idea,  sufficiently  explicit, 
of  the  mode  of  exhibiting  this  remedy,  to  observe, 
that  from  an  eighth  part  of  a  grain  to  one  grain  of 

*  Diseases  of  Hot  Climates. 


Jtemarfcs  on  the  Cholera  of  Infants.  383 

calomel,  combined  with  a  portion  of  opium,  from 
a  twentieth  part  of  a  grain  to  half  a  grain,  repeated 
every,  2d,  4th,  6th,  or  8th  hour,  will  comprise 
nearly  all  the  range  of  variety  necessary  in  the 
treatment  of  this  disease,  in  order  to  accommodate 
the  medicine  to  all  the  circumstances  of  age,  con- 
stitution, and  habit,  as  well  as  the  endless  differ- 
ences in  the  state  and  degree  of  the  complaint,  in 
the  concourse  and  succession  of  symptoms,  &c* 

It  will  scarcely  be  necessary  here  to  observe, 
that  not  only  the  relative  qualities  of  these  ingre- 
dients require  to  be  continually  varied  in  order  to 
meet  the  ever-varying  circumstances  above  men- 
tioned, but  that  frequently  one  or  the  other  article 
should  be  entirely  omitted,  accordingly  as  evacu- 
ation or  astriction  of  the  alimentary  canal,  or 
greater  or  less  degrees  of  either,  may  be  held  in. 
view. 

The  form  of  pill  was  commonly  preferred,  in 
prescribing  this  medicine.     If  the  child  was  too 

*  To  be  more  particular — a  child  about  two  years  old 
may  take  a  pill  composed  of  one  sixth  part  of  a  grain  of  opi 
urn,  and  one  third  part  of  a  grain  of  calomel,  every  second, 
fourth,  or  sixth  hour,  or  sometimes  oftener,  according  to  the 
urgency  of  the  symptoms.  If  much  evacuation  be  wished, 
the  above  quantity  of  calomel  is  too  small ;  if  much  astric- 
tion be  desired,  and  the  intestines  be  very  irritable,  it  will  be 
too  large.     And  so  also,  vice  versa,  with  respect  to  the  opium. 


384       Remarks  on  the  Cholera  of  Infants. 

young  to  swallow  an  entire  pill,  it  was  directed  to 
be  broken  into  small  fragments,  and  given  in  any 
pleasant  vehicle,  liquid  enough  to  be  readily  taken 
without  adhering  to  the  mouth,  and  of  sufficient 
consistence  to  entangle  the  small  pieces  of  the  pill. 
When  it  was  necessary  to  depart  from  this  mode, 
the  addition  of  a  little  white  sugar,  and  of  a  small 
portion  of  some  aromatic,  easily  formed  powders 
of  a  convenient  size. 

The  following  advantages  seem  to  attend  the 
use  of  this  medicine. 

1.  The  facility  of  exhibition.  Neither  article, 
when  properly  enveloped,  is  nauseating — the 
smallness  of  the  bulk,  and  the  agreeable  form  into 
which  it  may  be  reduced,  remove  every  difficulty. 
The  trouble  of  giving  unpalatable  remedies  to 
children  is  experienced  every  day  ;  and  the  trou- 
ble increases  with  the  bulk.  Impressions  on  the 
senses  frequently  affect  the  stomach,  especially 
when  enfeebled  by  disease  ;  hence  a  disagreeable 
taste  or  smell  will  sometimes  so  instantaneously 
produce  the  rejection  of  an  article  attempted  to  be 
swallowed. 

2.  The  difficulty  of  dislodging  it  from  the  sto- 
mach by  the  utmost  violence  of  vomiting.  The 
great  specific  gravity  of  the  calomel  seems  to  fa- 
vour the  retention  of  the  opium,  as  well  as  of  itself, 
on  the  stomach. 


Remarks  on  the  Cholera  of  Infants,      385 

3.  By  this  combination,  much  more  of  each  in- 
gredient, active  and  powerful  as  they  always  are, 
can  be  safely  and  advantageously  given,  than  in  a 
separate  state.  They  evidently  correct,  regulate, 
and  soften  the  powers  of  one  another. 

4.  It  is  calculated  to  obviate  the  most  fatal  ten- 
dencies of  the  disease.  When  a  fatal  termination 
takes  place  at  any  other  than  a  very  early  period, 
there  is  ground  to  conjecture  that  effusion  in  the 
head,  or  destruction  of  the  organization  of  the  sto- 
mach or  bowels,  commonly  takes  place.  The 
symptoms  of  determination  to  the  head  render  the 
former  probable ;  and  the  inflammatory, dysenteric, 
and  gangrenous  appearances  leave  little  doubt  of 
the  latter.  That  mercury  is  well  adapted  to  pre- 
vent consequences  such  as  these,  will  be  readily 
agreed. 

5.  Calomel,  combined  with  opium,  and  espe- 
cially when  exhibited  in  small  doses,  excites  a 
strong  absorbent  action,  with  respect  to  the  fluids 
poured  into  the  stomach  and  intestines.  Most  of 
the  metallic  salts  possess  more  or  less  of  the  same 
power.  The  degree  of  absorption  effected  by  the 
combination  of  calomel  and  opium,  will  probably 
be  in  proportion  to  the  quantity  and  completeness 
of  the  evacuations  previously  made  by  the  calomel 
alone,  or  other  evacuative  means  ;  as  absorptions 
in  general  are  increased  by  inanition. 

3  c 


386      Remarks  on  the  Cholera  of  Infants. 

It  will  be  difficult,  we  conceive,  to  appreciate 
the  virtues  of  calomel  in  the  cholera  of  children, 
unless  we  hold  in  constant  view  the  quantity,  vi- 
tiation, and  acrimony  of  the  contents  of  the  stomach 
and  bowels.  When  the  intestines  are  so  enfeebled 
and  diseased,  a  diarrhoea  may  be  present  for  man} 
days,  even  for  weeks ;  and  yet  excrementitious 
matters  may  collect  and  remain  in  such  quantity 
as  to  produce  the  greatest  mischief  by  their  pu- 
tridity and  excessive  stimulation.  In  what  manner 
shall  we  venture  to  expel  this  matter  ?  Physicians 
generally  agree,  that  calomel,  though  commonly 
safe  and  gentle  in  operation,  is  the  most  penetra- 
ting, detersive,  and  effectual  of  all  the  means  em- 
ployed to  cleanse  the  intestinal  canal ;  that  it  dis- 
lodges substances  not  to  be  moved  by  other  pur- 
gatives ;  and  often  discharges  more  bilious  and 
other  acrid  matter  of  every  description  at  one,  than 
other  cathartics  at  several  evacuations.  It  results 
then  from  all  this,  that  in  calomel  alone,  we  possess 
an  excellent  evacuant  in  the  diseases  denominated 
bilious  ;  and  that  in  calomel,  joined  to  opium,  we 
have  a  medicine  of  still  higher  value. 

Cases  may,  perhaps,  occur,  of  such  irritabilit) 
in  the  alimentary  canal,  that  no  portion  of  calomel 
can  be  borne,  even  in  connection  with  opium. 
Such  cases,  indeed,  we  have  not  yet  met  with ; 
but  supposing  them  to  happen,  we  should  advise, 
without  hesitation,  the  external  application  of  mer- 
cury. 


Remarks  on  the  Cholera  of  Infants.       387 

Upon  the  whole,  we  think  ourselves  warranted 
in  ascribing  a  superior  efficacy  to  the  action  of 
mercury  and  opium,  in  the  cholera  of  children. 
The  common  mode  of  treatment  appears  compa- 
ratively superficial  and  palliative ;  and,  of  conse- 
quence, the  effects  of  it  are  transient ;  while  mer- 
cury, penetrating  to  the  inmost  recesses  of  the 
disease,  and  disarming  it  of  all  malignity,  effectu- 
ates a  cure,  at  once  radical,  durable,  and  complete. 
Opiates  alone,  so  generally  used,  and  so  much 
confided  in,  afford  only  a  short-lived,  delusive  re- 
pose in  this  tumult  of  the  system. 

If  it  were  necessary  to  fortify,  by  authorities, 
the  mode  of  treatment  here  proposed,  it  would  be 
sufficient  to  mention  the  names  of  Doctor  Cleg- 
horn*  and  Dr.  Clark, f  who  place  a  principal  reli- 
ance on  a  combination  of  calomel  and  opium,  in 
the  worst  forms  of  dysentery.  Doctor  LysonsJ 
relates  a  number  of  cases  of  the  efficacy  of  a  simi- 
lar composition  in  the  bilious  diarrhoea  of  adults. 
Dr.  Chisholm§  depended  chiefly  on  the  same  me- 
dicine, given  in  such  manner  as  to  produce  a  rapid 
ptyalism,  in  the  malignant  fever  of  Boullam.  Doc- 
tor C.  Smith  employed  the  same  combination  to 
relieve  the  formidable  symptom  of  vomiting,  and 

*  Diseases  of  Minorca. 

|  Diseases  of  Hot  Climates. 

I  Practical  Essays. 

)  Essay  on  Malignant  Fever  of  Boullam. 


388       Remarks  on  the  Cholera  of  Infanta. 

found  it  successful,  when  all  other  means  had  fail- 
ed, in  the  jail  distemper.  *  And  Doctor  Armstrong 
used,  with  signal  advantage,  a  composition,  sub- 
stantially the  same,  in  the  disease  of  infants,  which 
he  denominates  the  watery  gripes.^  The  efficacy 
of  mercury,  also,  in  the  malignant  fevers  of  our 
own  country,  within  a  few  years,  is,  I  presume, 
too  well  known  to  need  being  mentioned  in  this 
place. 

In  the  advanced  stages  of  the  cholera  of  chil- 
dren, the  virtue  of  alum  deserves  much  com- 
mendation. All  acrid  and  offensive  matter  should, 
as  much  as  possible,  be  removed  before  the  use  of 
it  be  attempted.  It  is  thought  a  necessary  caution 
to  begin  with  it  in  very  small  doses,  as  half  a  grain, 
conjoined  with  opium,  and  gradually  to  increase 
them.  It  possesses  the  great  advantage  of  small 
bulk,  and  of  easy  envelopement  in  a  pill. 

To  the  preceding  observations  we  now  proceed 
to  subjoin  some  remarks  on  the  management  of 
the  state  and  temperature  of  the  skin  in  this  dis- 
ease. It  would  be  difficult  to  point  out  any  branch 
of  medical  attention  so  much  neglected  as  this  has 
too  generally  been.  The  importance  of  it,  in  all 
febrile  diseases,  is  unquestionable.  In  the  prin- 
ciples, however,  which  ought  to  guide  our  con- 

*  Description  of  Jail  Distemper,  p.  126. 
f  Diseases  of  Children,  p.  45. 


Remarks  on  the  Cholera  of  Infants.      389 

duct  on  this  point,  we  are  still  sorry  to  find  too 
much  indefiniteness  and  ambiguity.  And  although 
we  are  persuaded  many  firm  and  decisive  steps 
may  be  taken  beyond  the  common  practice  at  this 
time,  we  are  not,  at  present,  prepared  to  state  the 
limits,  or  deliver  the  rules  which  should  invariably 
govern  this  subject. 

As  the  cholera  of  children  is  a  febrile  disease, 
and  the  surface  of  the  body,  often  heated  far  be- 
yond the  proper  point,  it  will  be  advisable  to  ex- 
pose all  such  parts  of  the  skin  as  feel  too  warm  to 
the  hand,  to  a  stream  of  cool  air,  or  to  bathe  them 
in  cool  water.  Several  times  a  day  the  patient 
should  be  washed  with  vinegar  and  water,  salt  and 
water,  or  water  alone,  by  means  of  a  sponge,  as  he 
lies  in  bed,  with  as  little  motion,  disturbance,  or 
fatigue,  as  possible.  Considerable  inequality,  as 
to  the  heat  of  different  parts  of  the  body,  is  often 
observed.  If  some  parts,  as  the  extremities,  be 
too  cold,  they  should  be  covered  with  flannel ;  if 
other  parts,  as  the  face,  breast,  &c.  be  too  warm, 
they  should  be  cooled  by  a  stream  of  cold  air,  or 
by  bathing  them,  as  before  directed.* 

As  to  the  temperature  of  the  water  to  be  em- 
ployed for  this  purpose,  there  must  be  much  lat- 
itude of  discretion  in  different  circumstances,  as 
there  will  be  much  diversity  of  opinion  in  the 

*  Darwin's  Zoonomia,  vol.  ii.  p.  218. 


390       Remarks  on  the  Cholera  of  Infants. 

same  circumstances.  We  believe  it  may  be  safe- 
ly affirmed,  that  any  temperature  of  a  bath,  at,  or 
a  few  degrees  below,  the  healthy  standard  of  heat, 
in  the  human  body,  will  produce  a  speedy  and 
considerable  abatement  of  febrile  heat  on  the  skin. 
And  we  have  direct  conclusive  experiments  to 
prove,  that  such  a  bath,  from  95  to  85  degrees  of 
Fahrenheit's  thermometer,  when  duly  applied  to 
the  skin,  morbidly  hot,  will  powerfully  diminish 
the  celerity  of  the  pulse,  and  the  heat  of  the  body. 
But,  wherever  these  tepid  or  cool  degrees  of  the 
bath  do  not  sufficiently  carry  off  the  heat,  the  use 
of  colder  water  should  certainly  be  enjoined  ;  di- 
recting the  successive  reductions  of  temperature 
to  be  gradually  performed.  And  in  cases  where  a 
determination  to  the  head  is  indicated  by  unusual 
heat  of  that  part,  by  turgescence  and  redness  of 
the  face,  redness  of  the  eyes,  delirium,  &c.  the 
coldest  water  should  be  applied ;  and,  if  this  fail, 
powdered  ice  in  a  bladder,  as  recommended  by 
Dr.  Rush  in  yellow  fever,  f 

It  would  require  much  detail  to  enumerate  all 
the  advantages  of  these  applications.  Besides  ob- 
viating dangerous  determinations,  and  affording 
great  refreshment,  they  save  a  great  expenditure 
of  excitability,  and  thereby  preserve,  from  an  un- 
availing and  noxious  waste,  such  a  portion  of  vital 
power,  as  may  become  extremely  important  in  the 

f  Medical  Inquiries  and  Observations,  vol.  iv,  p.  91. 


Remarks  on  the  Cholera  of  Infants.         391 

perilous,  doubtful,  and  protracted  struggles  of  the 
system  with  this  disease. 

It  would  be  improper  here  to  pass  without  no- 
tice the  efficacy  of  cold  water,  or  iced  water,  as 
the  severity  of  the  case  may  require,  injected  into 
the  bowels.  This  operates  powerfully,  as  an 
anodyne,  sedative,  and  antispasmodic.  Besides 
actual  experience,  a  striking  analogy  in  favour  of 
this  remedy  is  presented  by  the  instantaneous  re- 
lief it  affords  in  the  retrograde  motions  of  the  ali- 
mentary canal,  which  take  place  in  hysteria,  men- 
tioned by  Dr.  Darwin  as  recommended  by  Mon- 
sieur Pomme.  Dr.  Darwin  explains  the  relief 
produced  in  this  case  by  supposing  "  the  invert- 
ed motions  of  the  intestinal  canal  to  be  checked  by 
the  torpor  occasioned  by  cold  ;  or  that  one  end  of 
the  intestinal  canal  may  become  strengthened,  and 
regain  its  peristaltic  motion  by  reverse  sympathy, 
when  the  other  end  is  rendered  torpid  by  ice  wa- 
ter." This  remedy,  though  generally  advisable, 
appears  to  be  most  adapted  to  that  period  of  the 
disease,  when  the  alimentary  canal  has  been  pre- 
viously well  emptied  of  its  acrid  and  offensive 
contents.* 

*  The  Spanish  physicians  (says  Cleghorn)  have  often 
assured  me,  that  they  found  nothing  more  beneficial  in  vio- 
lent deplorable  choleras,  than  drinking  of  cold  water. 
The  same  practice  is  recommended  by  many  of  the  ancients. 

Sin  autem  omnia  antiqua  ptercora  dejecta  fuerinl,  et  bili- 


392         Remarks  on  the  Cholera  of  Infants. 

In  addition  to  the  common  applications  to  the 
epigastrium,  or  other  convenient  parts,  blisters  are 
well  adapted  to  effect  a  change  in  the  state  of  the 
alimentary  canal.  If  the  propriety  of  applying 
them  in  the  early  part  of  the  disease  be  doubted, 
they  must  be  thought  unequivocally  proper,  after 
the  canal  shall  have  been  emptied  of  its  impurities, 
and  the  skin  become  generally  cooler  and  paler 
than  at  the  beginning.  Sinapisms  would  proba- 
bly answer  very  well  in  many  cases  ;  they  are  less 
painful  and  troublesome  than  blisters ;  and,  if  not 
suffered  to  lie  on  too  long,  will  produce  no  dis- 
agreeable effects. 

When  the  disease  is  sufficiently  subdued,  and 
the  retentive  powers  of  the  stomach  re-establish- 
ed, it  Mall  be  necessary  to  have  recourse  to  the 
common  corroborant  remedies  of  the  vegetable 
kind.  Among  these,  none  have  succeeded  so 
well,  m  my  hands,  as  infusions  or  decoctions  of 
Columbo  root,  or  Angustura  bark. 

o*i  huraores  transierint,  biliosusque  vomitus  et  distensio  adsit. 
fastidium,  anxietas,  virium  labefactio,  tunc  frigidae  aquas  cy- 
athi  duo  aut  tres  propmandi  sunt  ad  ventris  astrictionem,  ut 
retrogradus  humorum  cursus  cohibeatur,  atque  stomachus 
ardens  refrigeretur.  Assidue  vero  id,  quum  potam  aquam 
vomuerit,  facito.  Aret.  Cappad.  de  curat.  M.  A.  1.  ii.  c.  iv. 
See  likewise  Csel.  Aurel.  de  morb.  acut.  1.  iii.  r.  xxi.  Cl^g- 
horn's  Disease?  of  Minorca,  p.  243. 

FINIS. 


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